卡维地洛对高血压病并发2型糖尿病患者血管内皮功能及胰岛素抵抗的影响

Effects of carvedilol on vascular endothelial function and insulin resistance in hypertensive patients with diabetes mellitus

目的:探讨卡维地洛对高血压合并糖尿病患者血管内皮功能及胰岛素抵抗的影响。方法:经2周导入期后熏将41例高血压合并2型糖尿病患者熏随机分为卡维地洛组(21例)和美托洛尔组(20例)。治疗前及治疗6月后熏采静脉血测定空腹胰岛素、空腹血糖熏计算胰岛素敏感性指数;采用高分辨率超声检测反应性充血和硝酸甘油介导的肱动脉舒张功能。结果:卡维地洛治疗6月后,患者收缩压和舒张压均有效下降熏空腹胰岛素降低,胰岛素敏感指数显著升高熏反应性充血和硝酸甘油介导的血管舒张功能均明显改善。美托洛尔治疗后,空腹血糖和空腹胰岛素均轻度升高,胰岛素敏感指数降低,但差异均不具有统计学意义;反应性充血和硝酸甘油介导的血管舒张功能均无明显变化。结论:卡维地洛可有效降低高血压合并2型糖尿病患者的血压,改善胰岛素抵抗及肱动脉内皮依赖性及非内皮依赖性的血管舒张功能。

Objective: To investigate the effects of carvedilol on vascular endothelial function and insulin resistance in hypertensive patients with type 2 diabetes mellitus. Methods: Following discontinuation of any cardiovascular drugs for 2 weeks, 41 patients with arterial hypertension and diabetes mellitus were divided randomly into carvedilol group(21cases) and metoprolol group(20 cases). Before treatment and after 6 months of treatment, fasting glucose and insulin were measured. Insulin sensitivity index was calculated. Reactive congestion and nitroglycerin-induced dilation of the brachial artery were assayed with high-resolution ultrasound. Results:After 6 months of treatment, carvedilol significantly reduced blood pressure. Fasting insulin was reduced and insulin sensitivity index was increased significantly. Reactive congestion and nitroglycerin-induced vasodilatation were improved. And after 6 months of treatment with metoprolol, fasting blood sugar and insulin was increased and insulin sensitivity index was reduced slightly. Reactive congestion and nitroglycerin-induced vasodilatation were not improved. Conclusion: Carvedilol effectively reduced blood pressure and improved insulin resistance, endothelial-dependent vasodilatation and endothelial-independent vasodilatation in hypertensive patients with type 2 diabetes mellitus.