替米沙坦对老年代谢综合征患者血管内皮功能的影响

目的评估老年代谢综合征患者是否存在内皮依赖性血管舒张功能的损害，并探讨替米沙坦治疗前后代谢综合征患者血管内皮功能的变化。方法95例患者（≥60岁）按NCEP—ATPII代谢综合征诊断标准分为代谢综合征（MS）组63例，对照（非MS）组32例，利用高分辨率超声仪评价肱动脉内皮依赖的舒张功能。确诊的代谢综合征高血压患者30例采用替米沙坦治疗，于治疗前和治疗4m后评价肱动脉内皮依赖的舒张功能及胰岛素抵抗情况。结果代谢综合征患者内皮依赖的血管舒张功能（FMD）明显受损（4．90±3．0）％，与正常对照组（15．08±4．90）％比较，差异有统计学意义（P=0．034）。单因素相关分析显示血管内皮依赖性的舒张功能与年龄、空腹虹糖、胰岛素、HOMA、体重指数呈负相关。随访30名代谢综合征患者，替米沙坦服用4m后，内皮依赖的舒张功能（FMD）（9．37±2．97）％，与治疗前（5．65±3．26）％比较，差异有统计学意义（P=0．001）。治疗前后，患者的胰岛素抵抗亦有明显改善（P=0．001）。结论代谢综合征患者血管内皮依赖及非内皮依赖的血管舒张功能均有明显损害。替米沙坦能够有效地改善代谢综合征高血压患者胰岛素抵抗及血管内皮功能。

Effects of telmisartan on vascular endothelial function in elderly patients with metabolic syndrome

Objective To investigate the changes of endothelial function in patients with metabolic syndrome and to evaluate the effect of telmisartan on endothelial function and insulin resistance . Methods 95 cases （ ≥ 60 years） were divided into two groups： metabolic syndrome （63 cases） and placebo cor/trol group （32 cases）. The endothelial function was assessed by using ultrasound to measure the vasodilation of the brachial artery. After 4 months of telmisartan treatment, we used flow-mediated dilatation of the brachial artery and HOMA-IR to assess the endothelial function. Results Patients with metabolic syndrome had a progressive decline in the endothelium-dependent flow-mediated vasodilation （FMD） compare with that of the control group [（ 4.90 ±3.0） % vs （5.65 ±3.26 ） %] （P〈 0.05）. After 4 months of telmisartan treatment, endothelium-dependent vasodilation was significantly improved and insulin resistance was decreased in the patients with metabolic syndrome compared to before treatment. Conclusions Telmisartan can improves endothelial function and reduces insulin resistalace in the patients with metabolic syndrome, which may decreases the risk of cardiovascular disease.