Nicotinic acid as therapy for dyslipidemia in non-insulin-dependent diabetes mellitus.
Nicotinic acid as therapy for dyslipidemia in non-insulin-dependent diabetes mellitus.
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DOI：
10.1001/jama.1990.03450060069031
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发表时间：
1990-08
期刊：
影响因子：
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通讯作者：
A. Garg;S. Grundy
中科院分区：
文献类型：
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作者：
A. Garg;S. Grundy
最近，烟酸被推荐为一线降血脂药物。为了确定烟酸对非胰岛素依赖型糖尿病血脂异常患者的有效性，13例患者接受了随机交叉试验。患者接受烟酸（1.5 g，每日三次）或不接受治疗（对照期），每次8周。与对照组相比，烟酸治疗使血浆总胆固醇水平降低24%，血浆甘油三酯水平降低45%，极低密度脂蛋白胆固醇水平降低58%，低密度脂蛋白胆固醇水平降低15%，高密度脂蛋白胆固醇水平升高34%。然而，烟酸治疗导致血糖控制恶化，表现为平均血糖浓度增加16%，糖化血红蛋白水平增加21%，以及在一些患者中诱导明显的糖尿。此外，观察到血浆尿酸水平持续升高。因此，尽管脂质和脂蛋白浓度得到改善，但由于高血糖症恶化和高尿酸血症的发生，在非胰岛素依赖型糖尿病伴血脂异常患者中必须谨慎使用烟酸。我们建议不要将该药作为非胰岛素依赖型糖尿病患者的一线降血脂药物。
Recently, nicotinic acid has been recommended as a first-line hypolipidemic drug. To determine the effectiveness of nicotinic acid in dyslipidemic patients with non-insulin-dependent diabetes mellitus, 13 patients were treated in a randomized crossover trial. Patients received either nicotinic acid (1.5 g three times daily) or no therapy (control period) for 8 weeks each. Compared with the control period, nicotinic acid therapy reduced the plasma total cholesterol level by 24%, plasma triglyceride level by 45%, very-low-density lipoprotein cholesterol level by 58%, and low-density lipoprotein cholesterol level by 15%, and it increased the high-density lipoprotein cholesterol level by 34%. However, nicotinic acid therapy resulted in the deterioration of glycemic control, as evidenced by a 16% increase in mean plasma glucose concentrations, a 21% increase in glycosylated hemoglobin levels, and the induction of marked glycosuria in some patients. Furthermore, a consistent increase in plasma uric acid levels was observed. Therefore, despite improvement in lipid and lipoprotein concentrations, because of worsening hyperglycemia and the development of hyperuricemia, nicotinic acid must be used with caution in patients with non-insulin-dependent diabetes mellitus with dyslipidemia. We suggest that the drug not be used as a first-line hypolipidemic drug in patients with non-insulin-dependent diabetes mellitus.