【摘要】 目的 探讨新诊断T2DM合并颈动脉粥样硬化(CAS)患者血清对氧磷酶3(pon3)的水平及阿托伐他汀对血清pon3水平的影响。 方法 选择新诊断T2DM合并CAS患者87例，随机分为阿托伐他汀治疗组(A组，43例)和非诺贝特治疗组(B组，44例)。另选择健康体检者为对照组(C组，45例)。采用ELISA方法测定血清pon3水平，分析FPG、FIns、HbA1c、BMI、稳态模型评估法计算胰岛素抵抗指数(HOMA-IR)、同型半胱氨酸(Hcy)、纤维蛋白原(Fib)、高敏C反应蛋白(hsC-RP)、超氧化物歧化酶(SOD)、颈动脉-内膜中层厚度(IMT)与血清pon3水平的关系。观察T2DM合并CAS患者经阿托伐他汀、非诺贝特治疗前后血清pon3水平变化。 结果 (1)A和B组血清pon3水平[(3.55±0.54)和(3.61±0.51) ng/ml]均高于C组[(2.27±0.46) ng/ml](P<0.01);(2)血清pon3水平与BMI、FIns、LDL-C、HOMA-IR、hsC-RP、FPG、HbA1c、Hcy、Fib、IMT呈正相关(r分别为0.545、0.547、0.520、0.529、0.572、0.635、0.624、0.542、0.517、0.525，P<0.05或P<0.01);与HDL-C、SOD呈负相关(r=-0.565、-0.566);(3)治疗24周后，A组TC、TG、LDL-C、IMT、Hcy、Fib、hsC-RP较治疗前下降(P<0.05)，SOD、HDL-C、pon3水平较治疗前增高(P<0.05)，B组血脂变化与A组差异无统计学意义，IMT、Hcy、Fib、SOD、pon3较治疗前无明显差异;(4)多元逐步回归分析显示，IMT、HOMA-IR、Hcy、Fib是影响T2DM患者pon3的独立相关因素。HOMA-IR、Fib、Hcy、pon3是影响T2DM患者IMT的独立相关因素。 结论 阿托伐他汀能够降低新诊断T2DM合并CAS患者IMT，这与其升高血清pon3水平有关，不依赖其降脂作用。

　　【关键词】对氧磷酶3;糖尿病, 2型;颈动脉粥样硬化;阿托伐他汀

　　【Abstract】 Objective To investigate the effect of atorvastatin on serum paraoxonase-3(pon3) level in newly diagnosed T2DM patients with carotid atherosclerosis(CAS). Method 87 newly diagnosed T2DM patients with CAS were divided into atorvastatin treated group (group A, n=43) and fenofibrate treated group (group B, n=44). 45 healthy individuals with normal glucose tolerance were selected as the control (group C). Serum pon3 was measured by ELISA method. The association between serum pon3 levels and FPG, FIns, HbA1c, BMI, HOMA-IR, homocysteine(Hcy), fibrinogen(Fib), hsC-RP, superoxide,dismutase(SOD) and intima-media thickness(IMT) were also analyzed. Serum pon3 levels were observed in newly diagnosed T2DM patients with CAS before and after treatment. Results (1)Group A and B had significantly higher serum pon3 levels than group C(3.55±0.54, 3.61 ±0.51 vs 2.27±0.46, P<0.01, respectively). (2)Pearson correlation analysis showed that serum pon3 level was positively correlated with BMI, FIns, LDL-C, HOMA-IR, hsC-RP, FPG, HbA1c, Hcy, Fib and IMT(r=0.545, 0.547, 0.520, 0.529, 0.572, 0.635, 0.624, 0.542, 0.517, 0.525, P<0.05 or P<0.01, respectively); and was negatively correlated with HDL-C, SOD(r=-0.565,-0.566, P<0.05). (3)After 24-weeks treatment, serum pon3, SOD and HDL-C levels were significantly increased(P<0.05), while TC, TG, LDL-C, IMT, Hcy, Fib, hsC-RP levels were significantly decreased in group A(P<0.05), and group B had no significant difference of lipid profiles compared with group A，while IMT，Hcy，Fib，SOD，serum pon3 and hsC-RP levels have no significant difference. (4)Multiple stepwise regression analysis showed that IMT, HOMA-IR, Hcy and Fib were the independent related factors influencing the serum pon3 level of T2DM patients, and HOMA-IR, Fib, Hcy, pon3 were the independent related factors influencing IMT of the newly diagnosed T2DM patients with CAS. Conclusion Atorvastatin can decrease the IMT of newly diagnosed T2DM patients with CAS. This role is association with the increase of serum pon3, which is independent of its effects on reducing lipid.

　　【Key words】 Paraoxonase-3 (pon3); Diabetes mellitus, type 2; Carotid atherosclerosis(CAS); Atorvastatin