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目的探讨联合应用过氧化物酶体增殖物激活受体(peroxisome proliferator-activated receptor,PPAR)α/γ激动剂对糖尿病伴冠状动脉粥样硬化性心脏病(冠心病)患者血浆炎症因子的影响。方法将80例伴有糖尿病的冠心病患者分为马来酸罗格列酮组(n=20)、苯扎贝特组(n=20)、马来酸罗格列酮和苯扎贝特联合组(n=20)、常规治疗组(n=20)。治疗后,对所有患者随访12周。治疗前后均对所有患者采血,并用酶联免疫吸附法测定患者血浆C反应蛋白、单核细胞趋化蛋白-1(monocyte chemotactic protein-1,MCP-1),观察患者空腹血糖、空腹胰岛素、胰岛素抵抗指数、糖化血红蛋白-A1c(HbA1c)、血脂、体质量指数的改变。结果联合组、马来酸罗格列酮组、苯扎贝特组血浆C反应蛋白、MCP-1、空腹血糖、糖化血红蛋白、胰岛素、总胆固醇、三酰甘油、低密度脂蛋白胆固醇浓度和胰岛素抵抗指数治疗12周后比治疗前明显降低,高密度脂蛋白胆固醇明显升高,差异有统计学意义(P<0.05),且联合组上述指标改善最显著。马来酸罗格列酮组、苯扎贝特组、联合组的单核细胞在脂多糖诱导下分泌MCP-1浓度较治疗前降低,以联合组降低最为显著。C反应蛋白的降低与空腹胰岛素和胰岛素抵抗指数的降低呈正相关(r=0.498,P<0.001和r=0.496,P<0.001),与其他因素的变化无相关性(P>0.05);而MCP-1的变化与糖、脂代谢无相关性(P>0.05);C反应蛋白与MCP-1之间也无明显相关性(P>0.05)。结论联合应用马来酸罗格列酮、苯扎贝特能够降低血浆C反应蛋白和MCP-1浓度,降低血糖和血浆胰岛素浓度,减轻胰岛素抵抗,改善辛伐他汀治疗后残存的高三酰甘油和低高密度脂蛋白胆固醇,效果优于单用马来酸罗格列酮或苯扎贝特。
Objective To investigate the effects of peroxisome proliferator-activated receptor (PPAR) α / γ agonist on plasma inflammatory factors in patients with diabetes mellitus and coronary atherosclerotic heart disease (CHD). Methods Eighty coronary heart disease patients with diabetes were divided into rosiglitazone maleate group (n = 20), bezafibrate group (n = 20), rosiglitazone maleate and bezafibrate Combination group (n = 20), conventional treatment group (n = 20). After treatment, all patients were followed up for 12 weeks. Blood samples were obtained from all patients before and after treatment, and plasma C-reactive protein and monocyte chemotactic protein-1 (MCP-1) levels were measured by enzyme-linked immunosorbent assay. The fasting blood glucose, fasting insulin, insulin Resistance index, glycosylated hemoglobin-A1c (HbA1c), lipids, body mass index changes. Results The levels of plasma C-reactive protein, MCP-1, fasting plasma glucose, glycosylated hemoglobin, insulin, total cholesterol, triglyceride, low density lipoprotein cholesterol and insulin in the combination group, rosiglitazone maleate group and bezafibrate group After 12 weeks of treatment, the resistance index was significantly lower than that before treatment, and the level of high density lipoprotein cholesterol was significantly increased (P <0.05). The above indexes in the combined group were the most significant improvement. The concentrations of MCP-1 secreted by lipopolysaccharide-induced monocytes in rosiglitazone maleate group and bezafibrate group were lower than those before treatment, and the most significant decrease was found in combination group. The decrease of C-reactive protein was positively correlated with the decrease of fasting insulin and insulin resistance index (r = 0.498, P <0.001 and r = 0.496, P <0.001), but not with other factors (P> 0.05). There was no significant correlation between C-reactive protein and MCP-1 (P> 0.05). Conclusions Combination of rosiglitazone maleate and bezafibrate could decrease plasma C-reactive protein and MCP-1 concentration, decrease blood glucose and plasma insulin concentration, reduce insulin resistance, and improve the residual triglyceride and triglyceride after simvastatin treatment Low-density lipoprotein cholesterol is better than rosiglitazone maleate or bezafibrate alone.