不同他汀类药物治疗非酒精性脂肪性肝病合并高脂血症患者效果分析*

doi:10.3969/j.issn.1672-5069.2022.05.015

摘要/Abstract

摘要： 目的探讨应用不同的他汀类药物治疗非酒精性脂肪性肝病(NAFLD)合并高脂血症患者的近期疗效。方法 2019年9月～2021年5月我院收治的52例NAFLD合并高脂血症患者被分成两组,每组26例,分别给予阿托伐他汀或匹伐他汀治疗6个月。检测空腹胰岛素水平,计算胰岛素抵抗指数 (HOMA－IR) ,采用ELISA法检测血清肿瘤坏死因子-α ( TNF-α) 、白介素-6(IL-6) 、IL-8、超敏C反应蛋白(hs-CRP)水平,使用超声诊断仪检查肝脏声像图变化,使用Fibrotouch-B型诊断仪检测肝脏脂肪受控衰减参数(CAP)和肝硬度检测(LSM)。结果在治疗6个月末,匹伐他汀治疗组HOMA-IR、血清TC、TG和LDL-C水平分别为(2.1±0.5)、(3.5±0.4)mmol/L、(2.4±0.3)mmol/L和(2.2±0.5)mmol/L,均显著低于阿托伐他汀治疗组【分别为(2.5±0.4)、(4.2±1.0)mmol/L、(2.9±0.4)mmol/L和(2.9±0.7)mmol/L,P＜0.05】,而血清HDL-C水平为(1.6±0.4)mmol/L,显著高于阿托伐他汀治疗组【(1.3±0.3)mmol/L,P＜0.05】;两组血清TNF-α、hs-CRP、IL-6和IL-8水平比较,差异无统计学意义(P＞0.05);匹伐他汀治疗组CAP为(258.4±6.3)dB/m,显著低于阿托伐他汀治疗组【(267.7±10.2)dB/m,P＜0.05】;两组肝脏实质回声表现比较,无显著性差异(P＞0.05)。结论应用他汀类药物治疗NAFLD合并高脂血症患者近期疗效较好,可能与降低了血脂水平和胰岛素抵抗,改善了机体炎性反应有关,而应用匹伐他汀的效果可能更好,值得进一步观察。

关键词: 非酒精性脂肪性肝病, 高脂血症, 匹伐他汀, 阿托伐他汀, 治疗

Abstract: Objective The aim of this study was to investigate the short-term efficacy of different statins in treatment of patients with nonalcoholic fatty liver disease (NAFLD) and hyperlipidaemia. Methods 52 patients with NAFLD and hyperlipidaemia were encountered in our hospital between September 2019 and May 2021, and were divided into two groups, with 26 cases in each group, receiving pitavastatin or atorvastatin treatment for six months. The homeostasis model assessment-insulin resistance index (HOMA－IR) were obtained, and serum tumor necrosis factor-α ( TNF-α) , interleukin-6 (IL－6) , IL-8 and high-sensitivity C-reactive protein (hs-CRP) were detected by ELISA. The controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were recorded by FibroTouch. Results At the end of 6 months of treatment, the HOMA-IR, total cholesterol (TC), triglyceride (TG) and low density lipoprotein cholesterol (LDL- C ) levels in the pitavastatin-treated patients were (2.1±0.5), (3.5±0.4)mmol/L, (2.4±0.3)mmol/L and (2.2±0.5)mmol/L, significantly lower than [(2.5±0.4), (4.2±1.0)mmol/L, (2.9±0.4)mmol/L and (2.9±0.7)mmol/L, respectively, P＜0.05], while serum high density lipoprotein cholesterol (HDL－C) level was (1.6±0.4)mmol/L, significantly higher than [(1.3±0.3)mmol/L, P＜0.05] in atorvastatin-treated patients; there were no significant differences respect to serum cytokine levels between the two groups(P＞0.05); the CAP in the pitavastatin-treated patients was (258.4±6.3)dB/m, much lower than [(267.7±10.2)dB/m, P＜0.05] in atorvastatin-treated patients; there was no significant difference as respect to liver parenchymal echo manifestations (P＞0.05). Conclusion The statins could alleviate insulin resistance, reduce blood lipid levels and inhibit inflammatory reactions in patients with NAFLD and hyperlipidaemia, and the administration ofpitavastatinseems promising, and warrants further investigation.

Key words: Nonalcoholic fatty liver disease, Hyperlipidaemia, Pitavastatin, Atorvastatin, Therapy

潘飞, 寿涓, 张冬青. 不同他汀类药物治疗非酒精性脂肪性肝病合并高脂血症患者效果分析^*[J]. 实用肝脏病杂志, 2022, 25(5): 665-668.

Pan Fei, Shou Juan, Zhang Dongqing. Short-term efficacy of different statins in treatment of patients with nonalcoholic fatty liver disease and hyperlipidaemia[J]. Journal of Practical Hepatology, 2022, 25(5): 665-668.

参考文献

[1]方菊梅,张万里,陈怡发,等.非酒精性脂肪性肝炎患者血清sCD163和IL-1βmRNA水平变化及其临床意义探讨.实用肝脏病杂志,2020,23(3):368-371.
[2]Qu Y, Middleton MS, Loomba R,et al.Magnetic resonance elastography biomarkers for detection of histologic alterations in nonalcoholic fatty liver disease in the absence of fibrosis. Eur Radiol,2021,31(11):8408-8419.
[3]Troelstra MA, Witjes JJ,Dijk AM,et al. Assessment of imaging modalities against liver biopsy in nonalcoholic fatty liver disease: The Amsterdam NAFLD-NASH cohort. J Magn Reson Imaging, 2021,54(6):1937-1949.
[4]Salem WA, Elkady EF, Fouad MA,et al. DoEscreening and optimization of liquid chromatographic determination of nicotinic acid and six statins: Application to pharmaceutical preparations and counterfeit detection. J Chromatorg Sci, 2021,35(4):98-103.
[5]Athyros VG, Katsiki N, Mikhailidis DP. Clinical benefit of statin treatment on patients with non-alcoholic fatty liver disease or steatohepatitis. Clin Res Hepatol Gastroenterol,2021,46(4):101842.
[6]中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪肝专家委员会.非酒精性脂肪性肝病防治指南 (2018年版).实用肝脏病杂志,2018,21(2):177-186.
[7]诸骏仁,高润霖,赵水平,等.中国成人血脂异常防治指南(2016年修订版).中国循环杂志,2016,31(10):937-953.
[8]Kang SJ, Kwon A, Jung MK,et al. High prevalence of nonalcoholic fatty liver disease among adolescents and young adults with hypopituitarism due to growth hormone deficiency. Endocr Pract,2021,27(11):1149-1155.
[9]Luchtenborg C, Niederhaus B, Brugger B, et al. Lipid profiles of five essential phospholipid preparations for the treatment of nonalcoholic fatty liver disease: A Comparative Study. Lipids, 2020,55(3):271-278.
[10] Vilar-Gomez E, Gawrieh S, Liang T, et al. Interrogation of selected genes influencing serum LDL-cholesterol levels in patients with well characterized NAFLD. J Clin Lipidol, 2021,15(2):275-291.
[11] Hoffmann U, Lu MT, Olalere D,et al.Rationale and design of the mechanistic substudy of the randomized trial to prevent vascular events in HIV (REPRIEVE): effects of pitavastatin on coronary artery disease and inflammatory biomarkers. Am Heart J,2019,212(6):1-12.
[12] Castaneda PS, Dominguez CL, Cruz IMR,et al. Development of poly (methyl vinyl ether-alt-maleic acid) microneedles for transdermal delivery of atorvastatin calcium. Curr Pharm biotechnol, 2020,21(9):852-861.
[13] Chen LW, Lin CS, Tsai MC,et al.Pitavastatin exerts potent anti-inflammatory and immunomodulatory effects via the suppression of AP-1 signal transduction in human T cells. Int J Mol Sci, 2019,20(14):3534.
[14] Hajifathalian K, Tafesh Z, Rosenblatt R, et al. Effect of statin use on cancer-related mortality in nonalcoholic fatty liver disease: A prospective United States cohort study. J Clin Gastroenterol,2022,56(2):173-180.
[15] Cho Y, Rhee H, Kim YE,et al. Ezetimibe combination therapy with statin for non-alcoholic fatty liver disease: an open-label randomized controlled trial (ESSENTIAL study). BMC Med,2022,20(1):93.
[16] Yang Q, Zhang S, Wu S,et al. Identification of nafamostat mesylate as a selective stimulator of NK cell IFN-γ production via metabolism-related compound library screening.Immunol Res, 2022,15(9):1–11.
[17] Moroi M, Nagayama D, Hara F,et al. Outcome of pitavastatin versus atorvastatin therapy in patients with hypercholesterolemia at high risk for atherosclerotic cardiovascular disease. Int J Cardiol,2020,15(2):139-146.
[18] Hu N, Chen C, Wang J,et al. Atorvastatin ester regulates lipid metabolism in hyperlipidemia rats via the PPAR-signaling pathway and HMGCR expression in the liver.Int J Mol Sci,2021,22(20):11107.
[19] Diniz TA, Lima Junior EA, Teixeira AA,et al. Aerobic training improves NAFLD markers and insulin resistance through AMPK-PPAR-α signaling in obese mice. Life Sci,2021,26(6):1188-1189.
[20] Liu WT, Lin C, Tsai MC,et al.Effects of pitavastatin, atorvastatin, and rosuvastatin on the risk of New-Onset diabetes mellitus: A single-center cohort study. Biomedicines,2020,8(11):499.

不同他汀类药物治疗非酒精性脂肪性肝病合并高脂血症患者效果分析^*

Short-term efficacy of different statins in treatment of patients with nonalcoholic fatty liver disease and hyperlipidaemia

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