多因素干预对临界高血压合并代谢综合征影响的临床研究

目的 探讨不同治疗方式对临界高血压合并代谢综合征(MS)病变发展的影响。方法 将90例临界高血压合并MS患者按随机数字表法分为对照组、常规治疗组和强化治疗组，每组30例。对照组仅给予定期监测各项临床指标；常规治疗组根据病情服用相关药物；强化治疗组制定达标目标，予控制饮食、运动、健康教育及药物等综合治疗措施。各组均随访治疗1年，比较患者治疗前后各项临床指标的变化情况。结果 随访治疗1年后，对照组空腹血糖(FPG)、餐后2h血糖(2h PG)、24h尿微量白蛋白(24 h mAlb)、颈动脉内膜中层厚度(IMT)较治疗前明显升高，差异有统计学意义(P＜0.05)，其余各项指标治疗前后比较差异无统计学意义(P＞0.05)。常规治疗组治疗后FPG、2hPG、总胆固醇(TC)、三酰甘油(TG)较治疗前明显下降，颈动脉IMT较治疗前明显升高，差异有统计学意义(P＜0.05)，其余各项指标治疗前后比较差异无统计学意义(P＞0.05)。强化治疗组治疗后收缩压(SBP)、舒张压(DBP)、脉压(PP)、FPG、2hPG、TC、TG、高敏C反应蛋白(hs-CRP)、24 h mAlb、HOMA模型胰岛素抵抗指数(HOMA-IR)较治疗前明显下降，高密度脂蛋白胆固醇(HDL-C)、踝臂指数(ABI)较治疗前明显升高，差异有统计学意义（P＜0.01或＜0.05）。与常规治疗组治疗后比较，强化治疗组ABI、HDL-C升高，SBP、DBP、PP、TG、hs-CRP、24 h mAlb、HOMA-IR、颈动脉IMT下降(P＜ 0.01或＜0.05)。结论 临界高血压合并MS，一般药物治疗可获得部分临床指标的好转，给予综合强化治疗，能显著改善胰岛素抵抗，控制高血压的发生和发展，延缓血管病变。

Effects of multiple interference on borderline hypertension with metabolic syndrome

Objective To investigate the effects of different therapeutic methods on borderline hypertension with metabolic syndrome patients. Methods Ninety borderline hypertension with metabolic syndrome patients were divided into three groups by random digits table with 30 cases: control group,conventional therapy group and intensive therapy group. The control group was given regular observation, the conventional therapy group took drug according to the disease situation; and the intensive therapy group not only formulated the aim of therapy, but also received diet control, sport therapy, healthy education and drug therapy. After 1 year's follow-up, the patients' changes were compared. Results After 1 year's follow-up,the levels of FPG, 2 h PG, 24 h mAlb and IMT were significantly increased(P ＜ 0.05 ), and the levels of other index had no significant changes (P＞ 0.05) in control group. The levels of FPG,2 h PG,TC and TG were significantly decreased and IMT was significantly increased (P ＜0.05), the levels of other index had no significant changes(P ＞ 0.05 ) in conventional therapy group. The levels of SBP, DBP, PP, FPG, 2 h PG, TC,TG,hs-CRP,24 h mAlb and HOMA-IR were significantly decreased and HDL-C, ABI were significantly increased (P ＜ 0.01 or ＜ 0.05 ) in intensive therapy group. After treatment, the levels of ABI and H DL-C were significantly higher and SBP, DBP, PP,TG, hs-CRP, 24 h mAlb, HOMA-IR, IMT were significantly lower in intensive therapy group than those in conventional therapy group (P ＜ 0.01 or ＜ 0.05 ). Conclusions Drug therapy is efficient in borderline hypertension with metabolic syndrome patients, and intensive therapy can obviously improve the insulin resistance, to control the developing of hypertension can delay the vascular