不同糖耐量状态对高血压患者抗高血压药物治疗后代谢变化的影响  

Effect of Different Glucose Tolerance Status on Metabolism Change after Treatment with Antihypertensive Combination in Patients with Essential Hypertension

作　　者：章建梁[1] 秦永文[1] 郑兴[1] 邱健力[1] 龚莉[1] 毛红娟[1] 刘明[1] 郭冀珍[2] 

机构地区：[1]第二军医大学长海医院心血管内科,上海市200433 [2]上海瑞金医院高血压研究所

出　　处：《中国全科医学》2005年第4期270-272,275,共4页Chinese General Practice

摘　　要：目的　研究不同糖耐量状态对高血压患者抗高血压药物治疗后胰岛素抵抗 (IR)、血糖和血脂的影响。方法　将 138例轻、中度高血压患者随机分为 3组, 分别用复方降压片治疗 (第 1组 39例), 福辛普利和吲哚帕胺联合治疗 (第 2组 48例) 及尼群地平和阿替洛尔联合治疗 (第 3组 51例), 平均疗程 14个月。根据口服葡萄糖耐量试验将每组分为正常糖耐量亚组 (NGT) 和糖耐量减低亚组 (IGT)。根据Cederholm公式计算胰岛素敏感指数 (ISI) 作为IR指标, 观察血压、血糖、血脂的变化。结果　 (1) 3组患者降压效果间的差别无显著性意义 (P>0. 05)。 (2)第 1组患者治疗后两亚组的ISI提高; 两亚组患者血糖下降的幅度间差别无显著性意义 (P>0 .05), NGT亚组患者胆固醇升高。(3) 第 2组患者治疗后两亚组的ISI下降、血糖升高和高密度脂蛋白 /低密度脂蛋白的比值下降。 (4) 第 3组患者治疗后NGT亚组的ISI和高密度脂蛋白 /低密度脂蛋白的比值显著下降, 血糖显著升高; IGT亚组的ISI、血脂和血糖虽无显著变化, 但是有改善的趋势。结论　对不同糖耐量状态的高血压患者, 复方降压片治疗能减轻IR和改善血糖代谢, 福辛普利和吲哚帕胺联合用药则加重IR、恶化血糖和血脂代谢; 尼群地平和阿替洛尔联合治疗不利于NGT的高血压患者IR、血糖?Objective To investigate the effect of different glucose tolerance status on the change of insulin resistance (IR),blood glucose and blood lipid level after treatment with antihypertensive combination in patients with essential hypertension (EH).Methods 138 patients with mild to moderate EH were randomly divided into 3 groups:reserpine with dihydralazine,hydrochlorothiazide,potassium chloride group (group 1,n=39),fosinopril with indapamide group (group 2,n=48) and nifedipine with atenolol group(group 3,n=51).The treatment period lasted for 14 months.Every group was divided into normal glucose tolerance subgroup (NGT) and impaired glucose tolerance subgroup (IGT) according to oral glucose tolerance test.Before and after treatment,IR was measured by calculating insulin sensitivity index (ISI) according to Cederholm′ formula.Results (1) The total responsive rates were not significantly different between 3 groups.(2) After treatment,both the range of ISI increase and blood glucose decrease were not significantly different between NGT subgroup and IGT subgroup,and cholesterol was significantly increased in NGT subgroup of group 1.(3) After treatment,the range of ISI and high density lipoprotein-cholesterol (HDL-C)/low density lipoprotein-cholesterol (LDL-C) ratio decrease and the range of blood glucose increase were not significantly different between NGT subgroup and IGT subgroup in group 2.(4) After treatment,both ISI and HDL-C/LDL-C ratio were significantly decreased and blood glucose was significantly increased in NGT subgroup,however,there were improved trend in ISI,carbohydrate and lipid metabolism in IGT subgroup of group 3.Conclusion Treatment of combination of reserpine with dihydralazine,hydrochlorothiazide,potassium chloride has beneficial effect on improving insulin sensitivity and carbohydrate metabolism and treatment of combination of fosinopril with indapamide embitters IR and worsen carbohydrate and lipid metabolism in both NGT and IGT patients with EH.The treatment of combination of nifedipine w

关 键 词：高血压患者 治疗后 血糖 NGT 糖耐量 血脂 抗高血压药物 ISI 变化 结论 

分 类 号：R587[医药卫生—内分泌] R544.1[医药卫生—内科学]