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目的观察辛伐他汀治疗代谢综合征(MS)4周前后,C反应蛋白(CRP)及胰岛素抵抗的变化,并探讨辛伐他汀对代谢综合征的治疗作用。方法测定70例代谢综合征患者调脂治疗(辛伐他汀10mg/d,病程4周)前后及30例健康人(正常对照组)血脂、C反应蛋白、空腹胰岛素及计算胰岛素敏感性的变化。测定MS组辛伐他汀治疗前后,糖耐量试验前后血糖及胰岛素水平,并计算曲线下面积。分别分析血胆固醇,低密度脂蛋白,甘油三酯与血糖,C反应蛋白、胰岛素及其曲线下面积的相关性,C反应蛋白与胰岛素及其曲线下面积的相关性。结果①MS组应用辛伐他汀调脂治疗疗效肯定。②C反应蛋白在MS组显著高于正常组,MS组调脂治疗后比治疗前C反应蛋白下降了30%。③MS组胰岛素敏感性显著低于正常对照组(P<0·05),MS组空腹及糖负荷后胰岛素水平,血胰岛素/葡萄糖及各曲线下面积在治疗后均有下降(P<0·05),胰岛素敏感性指数上升。④MS组C反应蛋白与糖负荷后60min、120min胰岛素及胰岛素曲线下面积呈显著正相关(r分别为0·43,0·44,0·46,P均<0·05)。结论辛伐他汀治疗代谢综合征可显著降低C反应蛋白水平并改善胰岛素抵抗,具有抗血管内皮炎症反应的作用,并独立于降脂之外。
Objective To observe the changes of C-reactive protein (CRP) and insulin resistance in patients with metabolic syndrome (MS) before and after simvastatin treatment for 4 weeks and to explore the therapeutic effect of simvastatin on metabolic syndrome. Methods Serum lipids, C-reactive protein, fasting insulin and insulin sensitivity were measured in 70 patients with metabolic syndrome before and after lipid-lowering treatment (simvastatin 10 mg / d, duration of 4 weeks) and 30 healthy volunteers (normal control group). Before and after simvastatin treatment in MS group, glucose and insulin levels were measured before and after the glucose tolerance test, and the area under the curve was calculated. The correlation between serum cholesterol, low density lipoprotein, triglyceride and blood glucose, C-reactive protein, insulin and area under the curve and the area under the curve of insulin and C-reactive protein were analyzed. Results ① The effect of simvastatin on lipid lowering in MS group was confirmed. ② The level of C-reactive protein in MS group was significantly higher than that in normal group. In MS group, CR decreased by 30% compared with before treatment. (3) Insulin sensitivity in MS group was significantly lower than that in normal control group (P <0.05); fasting serum and insulin load, blood insulin / glucose and area under each curve in MS group were decreased after treatment (P <0.05) ), The insulin sensitivity index increased. (4) There was a significant positive correlation between the C-reactive protein and the area under the curve of insulin and insulin 120 min after 60 min and 120 min of insulin loading (r = 0.43, 0.46 and 0.46, P <0.05 respectively). Conclusion Simvastatin treatment of metabolic syndrome can significantly reduce the level of C-reactive protein and improve insulin resistance, anti-vascular endothelial inflammatory response, independent of lipid-lowering.