长期合用福辛普利和吲哚帕胺对高血压患者胰岛素抵抗及糖耐量的影响  

Effect of long-term treatment combined with fosinopril and indapamide on insulin resistance and glucose tolerance in patients with essential hypertension

作　　者：章建梁[1] 秦永文[1] 郑兴[1] 郑国龙[2] 刘明[1] 赵仙先[1] 陈少萍[1] 郭冀珍[3] 

机构地区：[1]第二军医大学长海医院心血管内科,上海200433 [2]武警福建总队医院内三科 [3]上海瑞金医院高血压研究所

出　　处：《中华全科医师杂志》2004年第6期361-365,共5页Chinese Journal of General Practitioners

摘　　要：目的　研究长期联合应用福辛普利和吲哚帕胺对高血压患者胰岛素抵抗 (IR)、血糖和血脂代谢等的影响。方法　 12 4例轻中度高血压患者随机分为观察组 (福辛普利和吲哚帕胺联合治疗 )和对照组 (单用福辛普利 ) ,92例完成研究 (观察组 4 8例 ,对照组 4 4例 ) ,服药 14个月 ,观察胰岛素敏感指数 (ISI)、血压、血糖、血脂、血钾等的变化。结果　观察组降压总有效率显著高于对照组( 97 9%比 75 0 % ,P <0 0 1) ,治疗后ISI显著下降 ( 5 5± 16比 4 8± 13,P <0 0 5 ) ,血糖和血脂升高 ;其中 2 9例患者停服吲哚帕胺后 ,ISI显著升高 (P <0 0 1) ,血糖和血脂改善。对照组治疗后ISI显著升高( 5 2± 16比 5 9± 19,P <0 0 1) ,血糖和血脂改善。结论　联合应用福辛普利和吲哚帕胺比单用福辛普利能更有效降低血压 ,但长期应用可加重高血压患者IR ,恶化血糖和血脂代谢。而单用福辛普利能改善高血压患者胰岛素敏感性 ,改善血糖和血脂代谢。提示吲哚帕胺可诱发糖尿病 。Objective To investigate the effect of long-term treatment combined with fosinopril and indapamide on insulin resistance (IR), blood glucose level and blood lipid metabolism in patients with essential hypertension (EH) Methods Ninety-two patients with mild or moderate EH were randomly divided into two groups, observation group with both fosinopril and indapamide combined ( n =48) and control group with fosinopril only ( n =44) Treatment lasted for 14 months Blood pressure, levels of blood glucose, lipid and potasiium were measured before and after treatment, and IR was evaluated by calculating insulin sensitivity index (ISI) according to Cederholm' formula Results Overall responsive rate in lowering blood pressure was higher in the observation group than that in the control group, with 97 9% (47/48) vs 75 0% (33/44), P <0 01, and ISI significantly decreased in the observation group, 55±16 vs 48±13, P <0 05 Blood levels of glucose and lipid increased remarkably, after treatment with fosinopril and indapamide combined, and seven patients were diagnosed as type 2 diabetes, ISI significantly increased, 47±12 vs 53±14, P <0 01, and blood levels of glucose and lipid remarkably improved in 29 of them 4～12-month after stopping indapamide One of seven diabetics dropped out from the follow-up, three turned to impaired glucose tolerance, one turned to normal glucose tolerance, and two remained diabetic As compared, ISI significantly increased in the control group, 52±16 vs 59±19, P <0 01, and blood levels of glucose and lipid improved remarkably Conclusions Treatment with fosinopril and indapamide combined could keep blood pressure under control more efficiently than that with fosinopril only for EH patients But, long-term treatment with both fosinopril and indapamide could aggravate IR and worsen carbohydrate and lipid metabolism in EH patients Long-term treatment with fosinopril only could improve insulin sensitivity and metabolism of carbohydrate and lipid in EH

关 键 词：血糖 福辛普利 高血压患者 对照组 血脂代谢 观察 胰岛素抵抗 ISI 结论 目的 

分 类 号：R544.1[医药卫生—心血管疾病]