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背景:迄今为止,他汀类药物对藏族这一特定民族的高尿酸血症合并高胆固醇血症患者的疗效尚未得到充分研究。目的:分析血尿酸与颈动脉内中膜厚度的关系,观察阿托伐他汀对高尿酸血症合并高胆固醇血症患者血脂、血尿酸及肝、肾功能指标的影响。设计:前后对照实验。单位:解放军总医院心内科,解放军西藏军区总医院心内科。对象:选择2005-08/2006-08在解放军西藏军区总医院心内科住院的高尿酸血症合并高胆固醇血症患者80例,年龄45～61岁。均来自拉萨市娘热乡;为藏族男性;均对检测项目知情同意。方法:①所有患者每晚口服阿托伐他汀20mg,连续12周。②在服药前及治疗后12周使用日立7600型全自动生化检测仪测定血尿酸、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿素氮、肌酐、谷丙转氨酶水平。B型超声测量颈动脉内中膜厚度。主要观察指标:①用药前后血脂、血尿酸及肝、肾功能指标比较。②心血管疾病危险因素与颈动脉内中膜厚度的关系。结果:总共80例患者入选本试验。①阿托伐他汀用药后总胆固醇、三酰甘油、低密度脂蛋白胆固醇和血尿酸水平分别降低33.8%,24.9%,12.2%,12.6%,差异有显著性意义(t=13.1534,3.8373,3.2201,2.7883,P<0.01)。用药前后高密度脂蛋白胆固醇、尿素氮、肌酐、转氨酶无明显变化(P>0.05),说明他汀类药物对肝肾功能无损伤。②用药前总胆固醇,三酰甘油,低、高密度脂蛋白胆固醇、血尿酸与内中膜厚度相关(β值=0.178,0.145,0.189,-0.181,0.284,P<0.05～0.01),其中血尿酸的(β值最高,表明血尿酸在颈动脉粥样硬化发生中所起的作用最大。结论:①血尿酸在颈动脉粥样硬化发生中起的作用最大。②阿托伐他汀可有效调血脂、降血尿酸,且无肝肾功能损害。
BACKGROUND: To date, the efficacy of statins in patients with hyperuricemia complicated with hypercholesterolemia in this particular ethnic group in Tibetans has not been well studied. OBJECTIVE: To analyze the relationship between serum uric acid and carotid intima-media thickness and to observe the effects of atorvastatin on serum lipids, serum uric acid, liver and renal function in patients with hyperuricemia and hypercholesterolemia. Design: before and after the control experiment. Unit: Department of Cardiology, People’s Liberation Army General Hospital, Department of Cardiology, General Hospital of Tibet Military Region, People’s Liberation Army. PARTICIPANTS: Eighty patients with hyperuricemia and hypercholesterolemia hospitalized in Department of Cardiology, People’s Liberation Army General Hospital of Tibet Military Command between August 2005 and August 2006 were selected, aged 45-61 years. All from Niang Hot Township in Lhasa; Tibetan men; informed consent of test items. Methods: ① All patients were given 20 mg of atorvastatin per night for 12 weeks. ② Serum uric acid, total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, blood urea nitrogen, creatinine, and alanine aminotransferase (ALT) were measured before and 12 weeks after treatment with Hitachi 7600 automatic biochemical analyzer Level. Type B ultrasound measurement of carotid intima-media thickness. MAIN OUTCOME MEASURES: ① Before and after treatment, blood lipid, serum uric acid and liver and kidney function indicators were compared. ② cardiovascular risk factors and carotid intima-media thickness. Results: A total of 80 patients were enrolled in this study. ① The levels of total cholesterol, triglyceride, low density lipoprotein cholesterol and serum uric acid in atorvastatin decreased by 33.8%, 24.9%, 12.2% and 12.6%, respectively, with significant difference (t = 13.1534, 3.8373, 3.2201 , 2.7883, P <0.01). Before and after treatment of high-density lipoprotein cholesterol, urea nitrogen, creatinine, transaminase no significant change (P> 0.05), indicating that statins on liver and kidney function without damage. ② Before treatment, total cholesterol, triglyceride, low and high density lipoprotein cholesterol, serum uric acid were correlated with thickness of intima (β = 0.178,0.145,0.189,0.181,0.284, P <0.05-0.01) Uric acid (β value is the highest, indicating that uric acid in carotid atherosclerosis play the most important role.Conclusion: ① uric acid in carotid atherosclerosis play the most important role. ② atorvastatin can effectively adjust Blood lipids, blood uric acid, and no liver and kidney dysfunction.