氯沙坦和氨氯地平对肥胖高血压患者瘦素、脂联素及胰岛素敏感性的影响

Effects of losartan and amlodipine on plasma leptin and adiponectin levels and insulin sensitivity in obese hypertensive patients

目的观察血管紧张素Ⅱ受体拮抗剂氯沙坦和钙离子通道拮抗剂氨氯地平对肥胖高血压患者血浆瘦素、脂联素、去甲肾上腺素(NE)水平和胰岛素敏感性的影响。方法采用放射免疫法测定血浆瘦素及脂联素水平、采用稳态模型评价胰岛素抵抗指数(HOMA-IR),以高效液相色谱检测血浆NE水平。结果氯沙坦组血浆瘦素、脂联素、HOMA-IR、体重指数(BMI)治疗16周前后差异有统计学意义[分别为(35.6±18.5 vs 32.0±17.1)μg/L,P<0.05;(9.34±3.12 vs 12.45±4.52)mg/L,P<0.01;8.6±2.7 vs 6.1±2.1,P<0.05;(28.9±3.8 vs 27.3±3.2)kg/m^2,P<0.05],氨氯地平组在治疗前后差异均无统计学意义[分别为(35.2±18.3 vs 35.4±18.9)μg/L;(9.32±3.23 vs 9.39±3.41)mg/L;8.3±2.5 vs 8.7±2.9;(28.8±3.8 vs 28.7±3.6)kg/m^2];血浆NE水平在氨氯地平组治疗后明显增加[(324±112 vs 449±122)ng/L,P<0.01],氯沙坦组治疗前后差异无统计学意义[(322±115 vs 325±121)ng/L],两治疗组之间的疗效差异有统计学意义(P<0.01)。结论虽然氯沙坦和氨氯地平有等同的降压效应,但氯沙坦尚能改善与肥胖相关的代谢紊乱,因此肥胖高血压患者用氯沙坦比氨氯地平治疗可能会获得更多益处。

Objective To observe the effects of losartan and amlodipine on blood pressure, plasma levels of leptin, adiponectin and norepinephrine （NE） and insulin sensitivity in obese hypertensive patients. Methods The levels of plasma leptin and adiponectin were determined by RIA and the plasma NE level was assayed by high-performance liquid chromatography. Insulin resistance index （HOMA-IR） was evaluated using the homeostasis model. Results Compared with basal levels, after 16-weeks＇ therapy, plasma leptin, HOMA-IR and body mass index were significantly decreased in losartan group [ （ 35.6±18.5 vs 32.0±17.1 ） μg/L, P 〈 0.05 ; 8.6 ± 2.7 vs 6.1 ± 2.1, P 〈0.05 ; （ 28.9 ± 3.8 vs 27.3 ± 3.2 ） kg/m^2, P 〈 0.05 ; respectively ], plasma adiponectin was significantly increased [ （9.34 ± 3.12 vs 12.45 ± 4.52）mg/L, P 〈 0.01 ], while no such changes were found in amlodipine group. Serum NE was significantly increased in amlodipine group after treatment [ （324 ± 112 vs 449 ± 122） ng/L, P 〈0.01 ], but it was not seen in losartan group [ （322 ± 115 vs 325 ± 121 ） ng/L]. ConcInsion In obese hypertensive patients, losartan and amlodipine exert similar antihypertensive effect, but losartan may help to improve some obesity-related disorders.