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醛固酮拮抗剂对代谢综合征合并慢性心力衰竭患者胰岛素抵抗指数和C-反应蛋白的影响
引用本文:胡怡,刘立旻,张斌,高阳,熊盈,魏敏,毛宇强,陈松,陈思娇,宋今丹.醛固酮拮抗剂对代谢综合征合并慢性心力衰竭患者胰岛素抵抗指数和C-反应蛋白的影响[J].中国全科医学,2008,11(15):1332-1334.
作者姓名:胡怡  刘立旻  张斌  高阳  熊盈  魏敏  毛宇强  陈松  陈思娇  宋今丹
作者单位:1. 中国医科大学附属第一医院老年病教研室,辽宁省沈阳市,110001
2. 中国医科大学医学分子生物学研究所卫生部细胞生物学重点实验室
3. 中国医科大学七年制医学专业
基金项目:辽宁省科技攻关项目 , 沈阳市科学技术计划项目 , 辽宁省自然科学基金项目 , 辽宁省高等学校科研项目
摘    要:目的观察醛固酮拮抗剂对代谢综合征合并慢性心力衰竭(心衰)患者胰岛素抵抗指数(HOMA-IR)、C-反应蛋白(CRP)的影响。方法将86例代谢综合征合并慢性心衰患者随机分成两组,常规治疗组(40例)使用洋地黄、利尿剂、血管紧张素转化酶抑制剂或血管紧张素受体拮抗剂、β-受体阻滞剂、硝酸酯类、降糖等治疗;醛固酮拮抗剂组(46例)在上述常规治疗基础上,加用醛固酮拮抗剂螺内酯20mg,2次/d,逐渐减至1次/d。治疗6个月。评估治疗前后两组患者临床疗效、HOMA-IR、CRP、血脂〔高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)〕水平和血压、心率。结果治疗后两组患者临床疗效间差别有统计学意义(P<0.01);HOMA-IR及CRP、HDL-C、LDL-C、TG水平、血压、心率间差别有统计学意义(P<0.05)。结论代谢综合征合并心衰患者在常规治疗的基础上加用醛固酮拮抗剂可能对提高胰岛素敏感性、降低CRP有一定作用。

关 键 词:醛固酮拮抗药  心力衰竭  慢性  C-反应蛋白质  胰岛素抵抗指数

Effect of Aldosterone Antagonist on IRI and CRP in Patients with Metabolic Syndrome Complicated by Chronic Heart Failure
HU Yi,LIU Li-min,ZHANG Bin,et al..Effect of Aldosterone Antagonist on IRI and CRP in Patients with Metabolic Syndrome Complicated by Chronic Heart Failure[J].Chinese General Practice,2008,11(15):1332-1334.
Authors:HU Yi  LIU Li-min  ZHANG Bin  
Institution:HU Yi,LIU Li-min,ZHANG Bin,et al.Teaching and Research Office for Geriatric Disease of the First Affiliated Hospital of China Medical University,Shenyang 110001,China
Abstract:Objective To evaluate the effect of Aldosterone antagonist on insulin resistance index(IRI)and C-reactive protein(CRP)in patients with metabolic syndrome complicated by chronic heart failure(CHF).Methods Totally 86 CHF patients were randomly divided into 2 groups:the patients in the group of conventional therapy(n=40)were given Digitalis,Diuretic agent,Angiotension converting enzyme inhibitor(ACEI)or angiotensin receptor blocker(ARB),Beta-receptor blockers,Nitrates and blood sugar reducing agents,and those in the group of Aldosterone antagonist(n=46)were given,based on the conventional therapy,Aldosterone antagonist(20mg,twice a day and the dosage was gradually decreased to 20mg/d).The course of treatment was 6 months.The clinical effect,IRI,CRP level,the levels of high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)and triglyceride(TG),blood pressure and,heart rate before and after the therapy were evaluated respectively.Results Before and after the therapy between the two groups,there was significant difference in clinical effect(P<0.01),and there were also significant differences in the levels of IRI,CRP,HDL-C,LDL-C and TG,as well as blood pressure and,heart rate(P<0.05).Conclusion The remedy of aldosterone antagonist based on the conventional therapy may effect for the patients with metabolic syndrome complicated by CHF to increase the sensitivity of insulin and reduce CRP.
Keywords:Aldosterone antagonists  Heart failure  chronic  C-reactive protein  Insulin resistance index
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