慢性充血性心力衰竭患者的胰岛素抵抗及药物干预的临床观察  

Clinical investigations of insulin resistance in patients with chronic congestive heart failure and drugs intervention

作　　者：李闽云 杨欣国[2] 张宁仔[2] 侯应龙[2] 郑强荪[2] 褚西秦[2] 

机构地区：[1]武警江西省总队医院心内科,江西南昌330001 [2]第四军医大学唐都医院心内科

出　　处：《心脏杂志》2000年第2期105-107,共3页Chinese Heart Journal

摘　　要：为观察慢性充血性心力衰竭 (CHF)患者的血胰岛素和糖代谢变化 ,进一步证实 CHF与胰岛素抵抗 (IR)的关系 ,并探讨福辛普利和吲哒帕胺对 CHF患者胰岛素敏感性的影响。对 CHF患者 4 0例检测福辛普利 (5mg～ 1 0mg,1次 / d)或吲哒帕胺 (2 .5mg,1次 / d)治疗前和治疗 4周后及 2 5例健康对照者空腹血糖 (FPG)、空腹血清胰岛素 (FINS)和空腹血清 C肽 (CP)水平 ,并计算出 FPG/ FINS比值、IAI值 [IAI=-ln(FPG× FINS) ]作为机体胰岛素敏感性评价指标 ,分别比较 CHF组与对照组、CHF组患者治疗前后的胰岛素敏感性变化。结果 :CHF组患者的胰岛素敏感性明显低于对照组 ,FINS水平高于对照组。治疗 4周后 ,福辛普利组 CHF患者的胰岛素敏感性显著增加 ,而吲哒帕胺组患者胰岛素敏感性无显著变化。提示 :1 CHF患者存在继发性 IR和 /或高胰岛素血症 ,IR和高胰岛素血症可能与 CHF患者心功能进一步恶化有关。 2福辛普利有改善 CHF患者To observe the changes in insulin sensitivity in patients with chronic congestive heart failure (CHF), assess the relation between CHF and insulin resistance (IR), and study the effects of fosinopril and indapamide on insulin sensitivity,fasting plasma glucose (FPG),fasting serum insulin (FINS) and fasting serum c peptide (CP) were measured in 40 patients with CHF before and after fosinopril (5~10 mg,q.d) or indapamide (2.5 mg,q.d) treatment for 4 weeks and in 25 healthy control subjects FPG/FINS and Ln1/FPG×FINS (IAI) were counted in each case. Insulin sensitivity was estimated by FPG/FINS and IAI. The results were compared with those of the control subjects. It was shown that the patients with CHF had lower insulin sensitivity and higher FINS levels. At the end of the 4th week after the treatment,insulin sensitivity was increased in fosinopril group but showed no change in the indapamide group. These results suggested that the patients with CHF suffered the secondary IR and/or hyperinsulinaemia. IR and hyperinsulinaemia may be responsible for the progressive deterioration of heart function and fosinopril can improve IR in patients with CHF.

关 键 词：充血性心力衰竭 胰岛素抗药性 福辛普利 

分 类 号：R541.610.5[医药卫生—心血管疾病]