替米沙坦对老年2型糖尿病合并高血压患者糖脂代谢及胰岛素敏感性的影响

 目的 探讨血管紧张素受体拮抗药替米沙坦对老年2型糖尿病合并高血压患者糖脂代谢及胰岛素敏感性的作用.方法 48例老年2型糖尿病合并高血压患者按体重指数(body mass index,BMI)分为非肥胖组和肥胖组.每位患者每天空腹口服80 mg替米沙坦,共24周.测定治疗前后BMI、腰臀比(waist-to-hip ratio,WHR)、胰岛素、血糖、血脂、血压、肝功能、肾功能、血管紧张素Ⅱ,计算稳态模型胰岛素抵抗指数(HOMA-IR).结果 替米沙坦治疗前,与非肥胖组相比,肥胖组收缩压(SBP)、舒张压(DBP)、三酰甘油(triglyceride,TG)、胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,LDL-C)、空腹血糖(fasting plasma glucose,FPG)、空腹胰岛素值(fasting insulin,FINS)、HOMA指数(homeostasis model assessment - insulin resistance index,HOMA-IR)和血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)均升高,差异有统计学意义(P<005).非肥胖组替米沙坦治疗后,SBP、FINS、HOMA-IR水平与治疗前相比均下降,ANGⅡ水平升高,差异有统计学意义.肥胖组替米沙坦治疗后,SBP、DBP、TG、TC、FPG、FINS、HOMA-IR水平与治疗前相比均下降,差异有统计学意义(P<005).结论 替米沙坦能够有效降低老年2型糖尿病合并高血压患者的血压,明显改善其糖、脂代谢状态,增强机体对胰岛素的敏感性.

Effects of telmisartan on metabolic changes and insulin sensitivity in elderly patients with type 2 diabetes mellitus and hypertension

Objective To evaluate the effect of telmisartan,an angiotensinⅡAT1 receptor blocker(ARB),on metabolism and insulin sensitivity in elderly patients with type 2.diabetes mellitus and hypertension.Methods Subjects were divided into two groups according to the body mass index(BMI):the group of nonobese patients(n = 20 ) and the group of obese patients(n = 28 ). All the patients were administered telmisartan 80mg/d for 24 weeks.BMI,waist hip ratio(WHR),systolic blood pressure(SBP), diastolic blood pressure(DBP),triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL -C),high density lipoprotein cholesterol(HDL - C),fasting plasma glucose(FPG),fasting insulin(FINS),HOMA - IR,and ANGⅡwere measured. Results In the basal state,SBP,DBP and levels of TG,TC,FPG,FINS,HOMA - IR and ANG II in the obese group were significantly higher than those in the nonobese group.Telmisartan treatment significantly reduced SBP,FINS,HOMA -IR,but increased ANGⅡlevels(all P<0.05) in the nonobese group.Similarly,reductions in SBP,DBP,TG,TC,FPG,FINS,HOMA -IR,and ANGⅡlevels(all P<0.05 ) were also seen in the obese group.Conclusions Telmisartan decreases blood pressure in elderly patients with type 2 diabetes mellitus and hypertension,especially patients with obesity,by improving the function of metabolism and insulin sensitivity.