培哚普利及氨氯地平联合治疗对原发性高血压患者自主神经功能及胰岛素抵抗和血清视黄醇结合蛋白4表达的影响  

Effects of perindopril and amlodipine on autonomic nervous function, insulin resistance and retinol binding protein 4 expression in patients with essential hypertension

作　　者：张淑霞[1] 梁焕[1] 赵国强[1] ZHANG Shuxia;LIANG Huan;ZHAO Guoqiang(Department of Geriatrics,the Second People’s Hospital of Hengshui,Hengshui 053000,China)

机构地区：[1]衡水市第二人民医院老年病科,053000

出　　处：《心肺血管病杂志》2019年第1期18-21,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨培哚普利与氨氯地平联合治疗对原发性高血压患者自主神经功能、胰岛素抵抗及血清视黄醇结合蛋白4(RBP4)表达的影响。方法:选择2016年2月至2017年9月,在我院接受治疗的老年原发性高血压患者87例进行研究,采用随机数字表法将其随机分为对照组43例和联合组44例。对照组给予氨氯地平治疗,联合组同时给予培哚普利治疗,连续治疗8周。比较两组患者治疗效果及治疗前后心率变异(HRV)、血压(BPV)指标、胰岛素抵抗指数(HOMA-IR)及血清RBP4水平变化情况,比较两组患者治疗过程中不良反应发生情况。结果:连续治疗8周后,联合组总有效率为95.5%,显著高于对照组的76.7%(χ~2=6.403,P=0.011);治疗后联合组患者的SDNN、SDANN、RMSSD、PNN50、SDNNindex等HRV各项指标均显著高于对照组(P<0.05);联合组治疗后HOMA-IR(24.48±6.16) mg/L,显著低于对照组的(27.39±5.92) mg/L(t=2.246,P=0.027),血清RBP4(3.94±0.89)g/mL,也显著低于对照组的(4.52±0.92)g/mL(t=2.989,P=0.004);治疗期间联合组不良反应发生率为11.4%(5/44),与对照组的9.3%(4/43)比较,差异无统计学意义(χ~2=0.100,P=0.752)。结论:培哚普利联合氨氯地平治疗老年原发性高血压效果显著,其可显著提升患者的心率变异性,降低胰岛素抵抗,这一作用可能是通过降低血清RBP4水平实现的,同时不会增加不良反应的发生,安全性高,值得临床推广应用。Objective:To investigate the effects of perindopril combined with amlodipine on autonomic nerve function,insulin resistance and serum retinol binding protein 4(retinol binding protein,RBP4)expression in patients with essential hypertension.Methods:A total of 87 elderly patients with essential hypertension received treatment in our hospital from February 2016 to September 2017 were randomly divided into the control group(43 cases)and the combined group(44 cases).The control group’s patients were treated with amlodipine,and the combined group’s patients were treated with amlodipine and Perindopril at the same time for 8 weeks.The therapeutic effect and heart rate variability(HRV),blood pressure variability(BPV),insulin resistance index(HOMA-IR)and serum RBP4 level before and after treatment were compared between the two groups.The adverse reactions were observed and compared in the two groups of patients.Results:The combination group total effective rate was 95.5%,which was significantly higher than the76.7%of the control group(χ^2=6.403,P=0.011);after treatment,the HRV indexes in the combined group were significantly higher than those in the control group(P<0.05).The HOMA-IR of the combined group was(24.48±6.16)mg/L after treatment,which was significantly lower than the control group’s(27.39±5.92)mg/L(t=2.246,P=0.027),the serum RBP4of the combination group after treatment was(3.94±0.89)g/mL,which was significantly lower than that of the control group’s(4.52±0.92)g/mL(t=2.989,P=0.004);the incidence of adverse reactions in the combined group was 11.4%(5/44)during the treatment,which showed no significant difference of 9.3%in the control group(4/43)(χ^2=0.100,P=0.752).Conclusions:Perindopril combined with amlodipine in treatment of elderly primary hypertension has significant effect and high safety,which can significantly improve the heart rate variability in patients,reduce insulin resistance,his effect may be achieved by reducing the level of the serum level of RBP4.

关 键 词：原发性高血压 视黄醇结合蛋白4 氨氯地平 培哚普利 心率变异性 胰岛素抵抗 

分 类 号：R54[医药卫生—心血管疾病]