卡托普利与缓释硝苯地平对高血压患者血清瘦素的影响

Effect of Captopril on Serum Leptin Compared with Nifedipine in Patients with Essential Hypertension

目的探讨卡托普利与缓释硝苯地平治疗对原发性高血压(EH)患者血清瘦素、胰岛素的影响及其差异。方法入选轻中度高血压患者44例(男24例,女20例),配对健康体检者22人(男12人,女10人),研究分为3组:正常对照组(C),卡托普利组(Ca)和硝苯地平组(Ni),每组各22例(男12例,女10例)。卡托普利起始用12·5mg,缓释硝苯地平10mg,2次/d,治疗2周血压未降至正常者,分别逐渐加至50mg和20mg,2次/d,治疗12周。观察体质量指数(BMI)、血压,空腹抽血测定血清瘦素、胰岛素、三酰甘油(TG)、胆固醇、血糖。12周后治疗组重复血压、BMI、瘦素、胰岛素、血糖测定。结果Ca和Ni两组除血压高于C组外,BMI、血糖、TG、胆固醇与C组无明显差异,高血压两组间上述参数相似。但Ca和Ni两组的血清瘦素[Ca(6·1±2·5)和Ni(6·4±3·1)vsC(5·0±1·4)μg/L,P<0·05)和胰岛素[Ca(9·1±5·5)和Ni(9·1±6·3)vsC(6·2±2·4)mIU/L,P<0·05)]均明显高于C组。Ca组治疗后血清瘦素明显降低[(6·1±2·5)vs(5·3±1·2)μg/L,P<0·05)],而Ni组无明显变化[(6·4±3·1)vs(6·5±2·5)μg/L]。结论高血压患者血清瘦素水平高于正常人,卡托普利治疗可降低瘦素水平,而硝苯地平则无明显影响。

Objective To explore the effect of captopril （Ca） and slow released nifedipine （Ni） on the level of the serum leptin and insulin in patient with essential hypertension（EH）. Methods Forty-four EH patients were dichotomized into two groups to receive Ca （12.5 mg/d, n=22） or slow released Ni （10 mg bid, n=22） and titrated to 50 mg/d for Ca or 20 mg for Ni bid if BP was sustained above 140/90 mm Hg 2 weeks after initiation of treatment. The control group （C） consisted of 22 healthy persons with normal BP. Baseline BMI, BP, serum leptin, insulin, and blood sugar （BS） were determined before and after treatment 12 weeks. Results The base-line age, sex, BMI, TG and CH had no difference between two EH groups and control group, however, baseline serum leptin was greater in the 2 EH groups compared with controls （Ca：6.1±2.5 and Ni：6.4±3.1 vs control： 5.2±1.9 μg/L, P〈0. 05）, as well as serum insulin （Ca： 9.1±5.5 and Ni： 12 weeks 9.1±6.3 vs control： 6.2±2.4 mlU/L, P〈0.05）. After 12 week treatment the serum leptin was decreased significantly in Ca group（6.1±2.5 vs 5.3±1.2 μg/L, P〈0.05）, but no change was found in by Ni： 6.4±3.1 vs 6.5±2.5μg/L, P〉 0.05）. Conclusion The serum leptin is higher in EH group than that in control group. Captopril treatment but not nifedipine lowered serum leptin.