摘要
目的:通过颈动脉超声监测2型糖尿病患者的颈动脉内膜中层厚度(IMT),比较西洛他唑与阿司匹林降低2型糖尿病患者颈动脉IMT的疗效。方法:选取2015年7月至2016年12月重庆医药高等专科学校附属第一医院收治的存在心血管事件风险因素的2型糖尿病患者312例,根据随机数字表法将患者分为阿司匹林组(n=156)与西洛他唑组(n=156)。阿司匹林组患者口服阿司匹林肠溶片治疗,1次100 mg,1日1次;西洛他唑组患者口服西洛他唑片治疗,1次100 mg,1日2次;观察及治疗周期为3年。对患者进行随访,比较两组患者基线,随访第1、2及3年的左侧颈动脉平均IMT、左侧颈动脉最大IMT(IMTmax)、右侧颈动脉平均IMT与右侧颈动脉IMTmax。记录并比较基线与随访3年后两组患者的临床指标水平、死亡情况、主要不良心血管事件发生情况及不良反应发生情况。结果:随访第1、2及3年,西洛他唑组患者左侧颈动脉平均IMT、左侧颈动脉IMTmax、右侧颈动脉平均IMT及右侧颈动脉IMTmax较基线明显降低,较同期阿司匹林组明显降低,差异均有统计学意义(P<0.05)。治疗后,西洛他唑组患者高密度脂蛋白胆固醇(HDL-C)水平(t=2.700,P=0.007)、25羟维生素D3[25(OH)D3]水平(t=4.605,P<0.007)及应用他汀类药物患者所占比例(χ^2=6.741,P=0.009)均较本组基线值明显升高;西洛他唑组患者HDL-C水平(t=2.354,P=0.019)、25(OH)D3水平(t=3.096,P=0.002)及应用他汀类药物患者所占比例(χ^2=4.446,P=0.035)均较同期阿司匹林组明显升高,上述差异均有统计学意义。两组患者死亡率、主要不良心血管事件发生率和不良反应发生率的差异均无统计学意义(P>0.05)。结论:与阿司匹林比较,西洛他唑可以显著降低存在心血管事件高风险因素2型糖尿病患者的颈动脉IMT,可以抑制动脉粥样硬化斑块形成,并通过血管舒张和抗血小板改善动脉粥样硬化。
OBJECTIVE:To compare the efficacy of cilostazol and aspirin in reducing carotid intima-media thickness(IMT)in patients with type 2 diabetes mellitus(T2DM)by monitoring the carotid IMT by carotid ultrasound.METHODS:Totally 312 patients with T2DM who had risk factors for cardiovascular events admitted into the First Affiliated Hospital of Chongqing Medical and Pharmaceutical College were extracted to be divided into the aspirin group(n=156)and the cilostazol group(n=156)via the random number table.The aspirin group was treated with Aspirin tablets,100 mg for once,qd;the cilostazol group received Cilostazol tablets,100 mg for once,bid.The observation and treatment cycle was 3 years.The patients were followed up,and the left-side carotid average IMT,left-side carotid maximum IMT(IMTmax),right-side carotid average IMT and right-side carotid IMTmax were compared between two groups at baseline,1,2 and 3 years of follow-up.The clinical and biochemical indicators of two groups at baseline and after 3 years of follow-up were recorded and compared,and the mortality,major adverse cardiovascular events(MACE),and incidence of adverse drug reactions between two groups were compared.RESULTS:After 1,2 and 3 years of follow-up,the left-side carotid average IMT,left-side carotid IMTmax,right-side carotid average IMT and right-side carotid IMTmax of cilostazol group were significantly lower than those of the baseline,and significantly lower than those of the aspirin group,the differences were statistically significant(P<0.05).After treatment,high-density lipoprotein cholesterol(HDL)levels(t=2.700,P=0.007),25-hydroxyvitamin D3[25(OH)D3]levels(t=4.605,P<0.007)and the proportion of patients with statins(χ^2=6.741,P=0.009)in the cilostazol group were significantly higher than that of the baseline.The HDL levels(t=2.354,P=0.019),25(OH)D3 levels(t=3.096,P=0.002)and the proportion of patients with statins(χ^2=4.446,P=0.035)in the celotazole group were significantly higher than those in the aspirin group,and the differences were statistically significant.There was no significant difference in mortality,incidence of major adverse cardiovascular events or adverse drug reactions between two groups(P>0.05).CONCLUSIONS:Compared with aspirin,cilostazol can significantly reduce IMT in T2DM patients with high risk factors for cardiovascular events,inhibit plaque formation and improve atherosclerosis through vasodilation and antiplatelet.
作者
孟瑶
邓敏
周厚地
伉奕
MENG Yao;DENG Min;ZHOU Houdi;KANG Yi(Dept. of Ultrasound, the First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, Chongqing 400060, China;Dept. of Endocrinology, the First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, Chongqing 400060, China;Dept. of Endocrinology, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, China;Dept.of Encephalopathy, Chongqing Jiulongpo District Hospital of Traditional Chinese Medicine, Chongqing 400080, China)
出处
《中国医院用药评价与分析》
2020年第7期773-777,共5页
Evaluation and Analysis of Drug-use in Hospitals of China
基金
重庆市卫生计生委医学科研项目(No.2015MXSM063)。
