替米沙坦对使用美托洛尔治疗的慢性心力衰竭合并高血压、糖耐量受损患者糖代谢的影响研究

目的探讨替米沙坦对使用美托洛尔治疗的慢性心力衰竭合并高血压、糖耐量受损(IGT)患者糖代谢的影响。方法选择2009年3月—2010年3月我院收治的慢性心力衰竭(充血性)合并高血压、IGT患者48例,按照随机数字表法将所有患者分为试验组和对照组,每组24例。两组患者均给予常规限盐饮食、卧床休息、抗栓、强心、利尿等治疗,并口服美托洛尔2次/d,对照组在此基础上口服贝那普利10 mg/d,试验组在此基础上口服替米沙坦80 mg/d;两组疗程均为8周。观察两组患者治疗前后心功能指标、糖代谢指标及临床疗效。结果两组患者治疗后左室射血分数(LVEF)均高于治疗前,左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)均低于治疗前(P0.05)。治疗后,试验组患者空腹血糖、餐后2 h血糖及胰岛素抵抗指数(HOMA-IR)低于对照组,空腹胰岛素高于对照组(P0.05);试验组患者治疗后空腹血糖、餐后2 h血糖及HOMA-IR低于治疗前,空腹胰岛素高于治疗前(P0.05)。试验组总有效率为95.83%(23/24),对照组为79.17%(19/24),试验组总有效率高于对照组(P0.05)。结论替米沙坦可明显改善使用美托洛尔治疗的慢性心力衰竭合并高血压、IGT患者的心功能及糖代谢,可减轻长期使用美托洛尔对糖代谢的影响,具有较好的临床疗效。

Effect of Telmisartan on Glucose Metabolism in Chronic Heart Failure Patients Combined with Hypertension and Im-paired Glucose Tolerance Treated by Metoprolol

Objective To explore the effect of telmisartan on glucose metabolism in chronic heart failure（ CHF） pa-tients combined with hypertension and impaired glucose tolerance（ IGT）treated by metoprolol. Methods From March 2009 to March 2010,48 congestive CHF patients combined with hypertension and IGT were selected and randomly divided into study group（n=24）and control group（n=24）,according to random numeric table method. Patients in both groups given conven-tional therapy,including salt restriction,bed rest,anti thrombosis,strengthening heart,diuresis,metoprolol twice per day;then patients in control group given benazepril 10 mg per day,study group given telmisartan 80 mg per day. Both groups treated for 8 weeks. Index of heart function and glucose metabolism before and after treatment,and clinical efficacy were observed. Re-sults LVEF in both groups after treatment were higher than that before treatment,while LVEDD,LVESD were lower（ P ﹤0. 05）. FBG,2 h postprandial glucose and HOMA-IR in study group were lower than those in control group after treatment, FINS was higher（P﹤0. 05）;FBG,2 h postprandial glucose and HOMA-IR in study group after treatment were lower than those before treatment,FINS was higher（P﹤0. 05）. The clinical efficacy of study group was 95. 83%（23/24）,was higher than that of control group of 79. 17%（19/24）（P﹤0. 05）. Conclusion Telmisartan can improve the heart function and glu-cose metabolism in CHF patients combined with hypertension and IGT,reduce the effect of long-term metoprolol taking,and has good clinical effect.