不同降压药物治疗对空腹血糖异常的高血压患者胰岛功能及胰岛素抵抗的影响

目的观察氯沙坦钾片与苯磺酸左旋氨氯地平片对空腹血糖异常的高血压病患者胰岛素抵抗的影响。方法选择既往无糖尿病史,空腹血糖>5.6 mmol/L且口服75 g无水葡萄糖耐量试验(oral glucose tolerance test,OGTT)后2 h PG<7.8 mmol/L的原发性高血压患者200例,随机分为2组,每组各100例,分别给予氯沙坦钾片(50～100 mg/d,根据患者个体差异而定)或苯磺酸左旋氨氯地平片(2.5～5.0 mg/d,根据患者个体差异而定)强化降压治疗12个月,并同时给予生活方式干预,在血压达标(BP<130/80 mmHg)的情况下,对比其治疗前后空腹胰岛素(fasting insulin,FINS)、OGTT2 h后胰岛素(2 hours fasting insulin,2 h INS)及胰岛素敏感指数(insulin sensitive index,ISI)的变化情况。结果 2组治疗后血压均较治疗前明显下降(P<0.05),治疗后氯沙坦钾组FINS水平下降,ISI较治疗前明显改善(P<0.05),与苯磺酸左旋氨氯地平组比较,差异具有统计学意义(P<0.05)。磺酸左旋氨氯地平组FINS、ISI治疗前后无明显变化(P>0.05)。治疗后2组2 h INS均无明显改善(P>0.05)。结论对于空腹血糖异常的高血压患者,氯沙坦钾较苯磺酸左旋氨氯地平更具有改善胰岛功能、降低胰岛素抵抗的优势,但两者对餐后胰岛素水平无明显作用,考虑与空腹血糖异常发病机制有关。

Effects of losartan potassium and levamlodipine besylate on islet function and insulin resistance in hypertension patients with impaired fasting glucose

Objective To compare the effects of antihypertensive agents losartan potassium and levamlodipine besylate on insulin resistance in primary hypertension patients with impaired fasting glucose.Methods A total of 200 primary hypertension patients(no diabetes history,fasting blood glucose >5.6 mmol/L,and postprandial 2 hours plasma glucose <7.8 mmol/L after oral glucose tolerance test by given 75 g glucosum anhydricum) were randomly divided into two groups(n=100).The patients were given losartan potassium(50 to 100 mg/d,according to patients with individual differences) and levamlodipine besylate(2.5 to 5.0 mg/d,according to patients with individual differences) for 12 months,respectively,and they were also given life style intervention at the same time.The changes of fasting insulin(FINS),2 hours fasting insulin(2 h INS) and insulin sensitive index(ISI) before and after the treatment were compared between the two groups when the patients’ blood pressure was lower than 130/80 mmHg.Results The patients’ blood pressure of the two groups decreased significantly after the treatment as compared with those before the treatment(P<0.05).FINS level significantly decreased and ISI significantly increased in the losartan potassium group(P<0.05) as compared with those in the levamlodipine besylate group(P<0.05),in which the FINS level and ISI showed no significant change before and after treatment(P>0.05).The 2 h INS level in both groups showed no significant improvement after treatment(P>0.05).Conclusion For hypertension patients with impaired fasting glucose,losartan potassium relieves insulin resistance more effectively than levamlodipine besylate does.Both of the drugs have no significant effect on 2 h INS,indicating relationship with the pathogenesis of impaired fasting glucose.