国产缬沙坦治疗2型糖尿病合并高血压患者的疗效观察  

Effect of valsartan on type 2 diabetes combined hypertensive patients

作　　者：蒋蕾[1] 孙明晓[1] 李慧[1] 汪耀[1] 迟家敏[1] 

机构地区：[1]卫生部北京医院内分泌科,100730

出　　处：《中华临床医师杂志（电子版）》2013年第12期60-63,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：国家"十一五"科技支撑计划(2006BAI02B08)

摘　　要：目的研究国产血管紧张素Ⅱ受体拮抗剂（ARB）类药物穗悦对2型糖尿病合并高血压患者的治疗效果。方法选取符合WHO的1999年2型糖尿病诊断标准，尿常规蛋白阴性的患者166例，年龄35～70岁，男90例，女76例，其中合并高血压者137例，按是否使用穗悦治疗分为穗悦组与非穗悦组，血压正常者29例，为对照组。所有患者每月测定血压，测定基线及治疗1年、2年时肝肾功能、血糖、糖化血红蛋白、8 h尿蛋白排泄率（UAER）、颈动脉内膜中层厚度（IMT）。结果（1）基线时穗悦组与非穗悦组及对照组比较，年龄、糖尿病病程、体质指数、肝肾功能、血糖、8 h UAER无显著差异（P＞0.05）。（2）基线时穗悦组高血压病程较长，收缩压及舒张压较非穗悦组显著增高（P＜0.05）；治疗1年及2年时，穗悦组收缩压与舒张压较治疗前均有显著下降（P＜0.05），收缩压仍稍高于非穗悦组与对照组，舒张压与非穗悦组及对照组无显著差异（P＞0.05）；非穗悦组仅2年时舒张压有显著下降（P＜0.05）。（3）基线时颈动脉IMT在穗悦组与非穗悦组间无明显差异，较对照组稍增厚；治疗1年及2年时，穗悦组与非穗悦组比较颈动脉IMT无显著差异（P＞0.05），较对照组仍稍增厚（P＜0.05）。（4）基线时8 h UAER穗悦组与非穗悦组比较，穗悦组与对照组比较均无显著差异（P＞0.05）；治疗2年时穗悦组8 h UAER有显著下降（P＜0.05）。结论穗悦在2型糖尿病合并高血压，尿常规蛋白阴性的患者中，能有效降低血压，尤其是舒张压，减少尿微量白蛋白排泄率，可能对动脉硬化有一定保护作用。Objective To evaluate the efficacy of valsartan on the treatment of hypertension in type 2 diabetes patients .Methods A total of 166 type 2 diabetes patients aged 35 to 70 years without proteinuria were eligible.137 patients with hypertension were assigned to receive valsartan （VAL group,n=83）80 mg once daily or other antihypertensive drugs（OAD group,n=54）for 2 years.29 type 2 diabetes patients without hypertension were in control group.Assessments were made at baseline and after 1 and 2 years of treatment.Results （1）There were no significant differences in age ,body mass index ,course of type 2 diabetes or microalbuminuria among the three groups （P〉0.05）.（2）The course of hypertension in VAL group was longer than OAD group ,and the systolic pressure and diastolic pressure in VAL group were higher than in OAD group at baseline .After 1 and 2 years treatment , the diastolic and systolic blood pressure significantly decreased in VAL group （P〈0.05）,but the systolic blood pressure was still higher than the other groups .The diastolic blood pressure had no difference among the three groups （ P〉0.05）,but it decreased in OAD group at the end comparing to baseline （P〈0.05）.（3）There were no significant differences in carotid intima-media thickness between VAL group and OAD group at baseline .Carotid intima-media thickness in VAL group was thicker than control group at the baseline .At the end of 2 years′therapy,there were no statistically significant differences in carotid intima-media thickness between VAL group and OAD group （ P〉0.05 ） . Carotid intima-media thickness in VAL group was thicker than control group （ P 〈0.05 ） .（ 4 ） There were no significant differences in UAER among the three groups （ P〉0.05 ） at the baseline .UAER was reduced significantly （P〈0.05）in VAL group 2 years later.Conclusion Valsartan is a safe and effective therapy for lowering BP in type＆amp;nbsp;2 diabetes patients without proteinuria ,especially of the systolic blood

关 键 词：糖尿病 2型 缬沙坦 尿微量蛋白排泄率 

分 类 号：R587.1[医药卫生—内分泌] R544.1[医药卫生—内科学]