卡维地洛和美托洛尔对高血压患者胰岛素抵抗、血糖及血脂影响的对比分析

目的 对比卡维地洛和美托洛尔对高血压患者胰岛素抵抗指数（HOMA-IR）、胰岛素敏感性指数（ISI）、血糖和血脂代谢的影响.方法 选择145例高血压1、2级患者,随机分为卡维地洛组72例和美托洛尔组73例,分别给予卡维地洛和美托洛尔口服治疗.两组分别分为无糖尿病和合并糖尿病亚组,无血脂异常组和合并血脂异常组.结果 治疗后卡维地洛组和美托洛尔组收缩压和舒张压均下降显著（P＜0.05）,卡维地洛组显效率和总有效率显著高于美托洛尔组（P＜0.05）.治疗前卡维地洛组和美托洛尔组各自的合并糖尿病亚组空腹血糖（FBP）、空腹胰岛素（FINS）、HOMA-IR、ISI水平与无糖尿病亚组有显著差异（P＜0.05）.治疗后卡维地洛组及其合并糖尿病亚组FBP、FINS、HOMA-IR、ISI水平与美托洛尔组及其合并糖尿病亚组有显著差异（P＜0.05）.无糖尿病组收缩压和舒张压分别与HOMA-IR呈显著正相关（r=0.356,0.375,P＜0.05）,与ISI呈负相关,但无统计学意义（r=-0.224,-0.251,P＞0.05）.治疗前卡维地洛组和美托洛尔组各自的合并血脂异常组总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平与无血脂异常组有显著差异（P＜0.05）.治疗后卡维地洛组及其合并血脂异常亚组FTC、TG、HDL-C、LDL-C水平与美托洛尔组及其合并血脂异常亚组有显著差异（P＜0.05）.结论 卡维地洛不仅具有良好的降低血压和控制血压的效果,还能改善高血压患者胰岛素抵抗和血糖、血脂代谢,可作为合并糖尿病、血脂异常及伴胰岛素抵抗的高血压患者较理想的降压药物.

Comparative analysis of effects of carvedilol and metoprolol for blood glucose,insulin resistance and lipid in patients with hypertension

Objective To study the effects of carvedilol and metoprolol on glucose and lipid metabolism in patients with HOMA-IR,ISI contrast. Methods 145 cases of. patients with grade 1, 2 hypertension were randomly divided into group of 72 cases of carvedilol and metoprolol group,73 patients were treated with carvedilol and metoprolol oral treatment. Each group was divided into two groups of non-diabetic and diabetic subgroup,no dyslipidemia group and dyslipidemia groups. Results After treatment, carvedilol group and metoprolol group,systolic and diastolic blood pressure decreased significantly （P 〈 0.05）,carvedilol significant efficiency and total efficiency were significantly higher than the metoprolol group （P 〈 0.05）. Before treatment,the earvedilol group and metoprolol group their diabetes, FBP, FINS, HOMA-IR, ISI level with non-diabetic group were significantly different （P 〈 0.05）. Treatment carvedilol group and diabetes group FBP,FINS,HOMA-IR,ISI level vs metoprolol group and diabetes group were significantly different （P 〈 0.05）. Systolic and diastolic blood pressure without diabetes group with HOMA-IR were significantly positive correlation （r = 0.356,0.375 ,P 〈 0.05）,negatively correlated with ISI,but had not statistically significant （r = -0.224,-0.251 ,P 〈 O.05）.Before treatment,the carvedilol group and metoprolol group respective dyslipidemia TC,TG,HDL-C,LDL- C ievels and dyslipidemia group had no significant difference （P 〈 0.05）. Carvedilol group and treatment dyslipidemia group FFC,TG,HDL-C ,LDL-C levels vs the metoprolol group and dyslipidemia groups were significantly different （P 〈 0.05）. Conclusion Carvedilol not only has good control of blood pressure lowering blood pressure and the effect, but also improve blood pressure in patients with insulin resistance and glucose and lipid metabolism,as diabetes,dyslipidemia and insulin resistance in hypertensive patients with an ideal antihypertensive drugs.