| Research background:The rapid development of economy has improved people’s quality of life.Under the influence of many factors,the number of people with hyperglycemia and hyperlipidemia increases,the prevalence of coronary heart disease increase continuously.Statins are the most commonly used lipid-lowering drugs in clinical practice,it has been routinely used in primary and secondary prevention of cardiovascular diseases.In recent years,a large number of studies have sured that statins have significant beneficial effects on CVD,and the clinical risks caused by statins have attracted more attention.Studies have found that statins affect glucose metabolism,and long-term use increases about 9%of new-onset diabetes.High-intensity statins can increase the risk of NODM compared with moderate intensity statins.Pitavastatin is a new member of statins with unique structure and remarkable lipid-lowering effect.Some studies have pointed out that pitavastatin does not seem to affect glucose metabolism,and can even improve glucose metabolism,but the specific mechanism is not clear.This conclusion has not been uniformly recognized and controversial.More clinical studies are still needed to confirm the effect of pitavastatin on blood glucose,lipid-lowering efficacy and adverse reactions,so as to provide a reliable argument for the clinical application of pitavastatin.Objective:The aim of this study was to evaluate the effects of pitavastatin（2mg/d）and atorvastatin（20mg/d）on blood glucose,serum lipids,liver function and renal function in non-diabetic and CHD patients with PCI after operation,and clinical adverse reactions.Method:Selecte PCI and non-diabetic patients from October 2019 to March 2021,cardiovascular department of Jiangsu Subei People’s Hospital,take secondary preventive drugs for CHD regularly after operation regularly.A total of 569 patients who met the inclusion criteria and did not meet the exclusion criteria were included in this study finally,Among them,364 patients with oral atorvastatin（20mg/D,1 tablet before going to bed every night）were classified as atorvastatin group（ATO group）,205 patients with oral pitavastatin（2mg/D,1tablet before going to bed every night）were classified as pitavastatin group（PIT group）.Through case system collected the baseline data of the two groups,the laboratory indexes at 6 and 12 months of drug treatment,including fasting venous blood glucose,blood lipid,liver function and renal function.The clinical adverse reactions during the medication were recorded by outpatient case department and telephone follow-up,including muscle soreness,limb weakness,abdominal pain,nausea,allergy,etc.The relevant indexes were compared within and between groups before and after treatment.In addition,321 healthy people who underwent physical examination in the health management center for two consecutive years during this period were selected to record the test indexes of physical examination and compare the changes of blood glucose and blood lipid.Resultes:1.Comparison of baseline levels of general clinical data and laboratory indexes:there was no significant difference between atorvastatin group and pitavastatin group in clinical datagender ratio.There was no significant difference in blood glucose,blood lipid,liver function,renal function and blood routine indexes between the two groups before treatment（p<0.05）.2.Comparison of blood lipid levels:after 6 and 12 months of treatment,the levels of total cholesterol,triglyceride and low-density lipoprotein cholesterol in atorvastatin group and pitavastatin group were significantly lower than those before treatment（p<0.05）,and the levels of HDL-C were higher than those before treatment（p<0.05）.After 6 and 12 months of treatment,there was no significant difference in blood lipid level between the two groups（p>0.05）,and there was no difference in the level of HDL-C between the two groups after 6 months of treatment.After 12 months of treatment,the level of HDL-C in pitavastatin group was significantly higher than that in atorvastatin group（p<0.05）,and there was no significant difference in the lipid-lowering effect of the two statins.3.Comparison of blood glucose level:after 6 and 12 months of treatment,the fasting blood glucose level in atorvastatin group was higher than that before treatment（p<0.05）.After 6 months of treatment,the fasting blood glucose level in pitavastatin group was higher than that before treatment（p<0.05）,and the degree of increase was weaker than that in atorvastatin group.After 12 months of treatment,the fasting blood glucose level was significantly lower than that before treatment（p<0.05）.After 6 and 12 months of treatment,the fasting blood glucose of atorvastatin group was higher than that of pitavastatin group（p<0.05）.4.The fasting blood glucose of the healthy population group had an upward trend for two consecutive years,and the blood lipid level had no significant change（p<0.05）.5.Comparison of liver function:after 6 months of treatment,the levels of alanine aminotransfease,aspartate aminotransfease,ggamma-glutamyltransferase,total bilirubin and direct bilirubin in atorvastatin group were higher than those before treatment（p<0.05）.After 12 months of treatment,ALT and AST had no significant change,while GGT,TBIL and DBIL were significantly higher than those before treatment（p<0.05）.After 6 months and 12 months of treatment,the levels of lactic dehydrogenase and alkaline phosphatase had no significant change.In pitavastatin group,ALT,AST,TBIL and DBIL increased after 6 months of treatment（p<0.05）,ALT and AST did not change significantly after 12 months of treatment,TBIL and DBIL increased significantly（p<0.05）.After 6 months and 12 months of treatment,and the levels of GGT,LDH and ALP did not change significantly.There were no significant difference in liver function indicators between groups after 6 and 12 months of treatment（p>0.05）.6.Comparison of renal function:there was no significant change in the level of serum creatinine between the two groups after 6 months of treatment（p>0.05）,and the level of SCR decreased significantly after 12 months of treatment（p<0.05）.The reduction degree of atorvastatin group was stronger than that of pitavastatin group.After 6 and 12 months of treatment,the levels of blood urea nitrogen and uric acid in pitavastatin group had no significant change compared with those before treatment.After 6 months of treatment,the levels of BUN and UA in atorvastatin group were significantly lower than those before treatment（p<0.05）,and there was no significant change in the levels of BUN and UA after 12 months of treatment.There was no significant difference in the levels of SCR,BUN and UA between the two groups after 6 and 12 months of treatment（p>0.05）.7.Safety comparison:there was no significant difference in adverse events between the two groups during follow-up（p>0.05）.Conclusion:1.Pitavastatin and atorvastatin have a positive effect on the level of blood lipids in non-diabetic and CHD patients after PCI,the effect of lipid regulation is similar,and goodsafety.Compared with atorvastatin,pitavastatin has a better effect on increasing the level of HDL-C.2.The longer the medication,the smaller the effect of pitavastatin on blood glucose and even improve blood glucose,atorvastatin will cause a slight increase in blood glucose.3.The effect of pitavastatin on liver function is weaker than atorvastatin,suggesting that the safety may be more advantageous.4.Both statins showed a trend of improving renal function indexes during treatment,especially in atorvastatin group. |
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