摘要：
目的 观察脂必妥联合阿托伐他汀治疗2型糖尿病合并高脂血症的效果及其对血脂、纤维蛋白原(Fib)和D-二聚体的影响.方法 选取2010年1月至2012年12月在我院门诊就诊的2型糖尿病合并高脂血症患者170例,应用随机数字表分为观察组和对照组,每组85例.对照组予以阿托伐他汀10 mg、1次/d口服治疗,观察组在对照组的基础上予以脂必妥1.05 g、2次/d口服治疗,疗程均为8周,观察两组治疗前后空腹血糖(FPG)、糖化血红蛋白(HbA1c)、Fib、D-二聚体和血脂的变化,比较两组的疗效.结果 观察组的总有效率为92.94％(79/85),对照组为81.18％ (69/85),观察组的有效率高于对照组,差异有统计学意义(x2=4.229,P＜0.05).观察组治疗前后的总胆固醇[(7.46±1.83)、(4.28±1.94) mmol/L]、甘油三酯[(3.57±1.32)、(1.47±0.86) mmol/L]、低密度脂蛋白胆固醇[(4.68±1.04)、(2.19±0.72)mmol/L],高密度脂蛋白胆固醇[(0.85±0.21)、(1.47±0.43)mmol/L]、FPG[(8.65±2.19)、(6.38±0.83) mmol/L]、HbAlc[(7.49±1.67)％、(6.28±1.48)％]、Fib[(7.42±1.38)、(3.76±1.18) mg/L]和D-二聚体[(1.18±0.17)、(0.51±0.18) g/L]差异均有统计学意义(t值分别为10.993、12.289、18.849、11.945、8.936、4.999、18.584、24.949,P均＜0.05)；对照组治疗前后总胆固醇[(7.51±1.27)、(5.10±2.18) mmol/L]、甘油三酯[(3.48±1.29)、(1.88±0.37)mmol/L]、低密度脂蛋白胆固醇[(4.57±1.18)、(2.81±0.83) mmol/L]、高密度脂蛋白胆固醇[(0.83±0.22)、(1.16±0.28) mmol/L]、FPG[(8.72±1.92)、(7.42±1.82) mmol/L]、HbA1c[(7.53±1.32)％、(6.79±1.23)％]、Fib[(7.38±1.63)、(4.41±1.02) mg/L]和D-二聚体[(1.20±0.15)、(0.65±0.12)g/L]差异均有统计学意义(t值分别为8.807、10.992、11.248、8.544、4.530、3.781、14.240、26.397,P均＜0.05),但治疗组改善程度优于对照组(t值分别为2.591、4.038、5.202、5.570、4.793、2.443、3.842、5.967,P均＜0.01).结论 脂必妥联合阿托伐他汀治疗2型糖尿病合并高脂血症的效果显著,并且对机体的纤溶和凝血功能紊乱具有调节作用.%Objective To observe the efficacy of zhibituo combined with atorvastatin on type 2 diabetic patients with hyperlipidemia and its impact on blood lipids,fibrinogen (Fib) and D-dimer.Methods One hundred and seventy type 2 diabetic patients with hyperlipidemia visited our hospital from January 2010 to December 2012 were randomly divided into observation group and control group(with 85 cases in each group).Control group were given atorvastatin (1 0 mg,1 times / day),and the observation group were treated with zhibituo(1.05 g,3 times/day) on the basis of atorvastatin treatment,both treatment were 8 weeks.The levels of fasting plasma glucose (FPG),glycosylated hemoglobin (HbAlc),lipids,Fib and D-dimer were observed before and after treatment,and the efficacy of the two groups were compared.Results The efficacy in observation group was significantly higher than that in the control group (92.94％ (79/85) vs.81.18％ (69/85),x2 =4.229,P ＜ 0.05).There was significant difference on the levels of total cholesterol (TC) ((7.46 ±1.83) mmol/L vs.(4.28 ± 1.94) mmol/L,triglycerides (TG) (3.57 ± 1.32) mmoL/L vs.(1.47 ± 0.86)mmol/L,low-density lipoprotein cholesterol (LDL-C) (4.68 ± 1.04) mmol/L vs.(2.19 ± 0.72) mmol/L,high density lipoprotein cholesterol (HDL-C) (0.85 ± 0.21) mmol/L,vs.1.47 ± 0.43) mmol/L,fasting plasma glucose (FPG) ((8.65 ± 2.19) mmol/L vs.(6.38 ± 0.83) mmol/L).glvcosvlated hemoglobin (HbAlc) ((7.49 ± 1.67)％ vs.(6.28 ± 1.48)％),fibre(FiB) ((7.42 ± 1.38) mg/L vs.(3.76 ± 1.18)mg/L),and D-dimer ((1.18 ±0.17) g/L vs.(0.51 ±0.18) g/L) in observation group before and after treatment(t =10.993,12.289,18.849,11.945,8.936,4.999,18.584,24.949 respectively,all P ＜ 0.05).And there was also significant difference on the levels ofTC ((7.51 ± 1.27) mmol/L vs.(5.10 ±2.18) mmol/L),TG((3.48 ± 1.29) mmol/L vs.(1.88 ±0.37) mmol/L),LDL-C((4.57 ± 1.18) mmol/L vs.(2.81 ±0.83) mmol/L),HDL-C ((0.83 ± 0.22) mmol/L vs.(1.16 ± 0.28) mmol/L),FPG((8.72 ± 1.92) mmol/L vs.(7.42 ± 1.82) mmol/L),HbAlc((7.53 ± 1.32)％ vs.(6.79 ± 1.23)％),Fib((7.38 ± 1.63) mg/L vs.(4.41 ± 1.02) mg/L) and D-dimer ((1.20 ±0.15) g/L vs.(0.65 ±0.12) g/L) in control group before and after treatment (t =8.807,10.992,11.248,8.544,4.530,3.781,14.240,26.397,respectively,all P ＜0.05).The elevated levels of the observation group were more obvious compared with control group ((t =2.591,4.038,5.202,5.570,4.793,2.443,3.842,5.967 respectively,all P ＜0.01).Conclusion The efficacy of zhibituo combined with atorvastatin is obvious in type 2 diabetic patients with hyperlipidemia,it is helpful to regulate the disorders of fibrinolysis and coagulation.
