缬沙坦对高血压糖尿病合并胰岛素抵抗和勃起功能障碍患者C-反应蛋白及性功能的作用

Effect of Losartan on C-Reactive Protein and Sexual Function in Patients with Hypertension and Diabetes Merging Insulin Resistance and Erectile Dysfunction

目的评价缬沙坦对高血压糖尿病合并胰岛素抵抗(IR)、勃起功能障碍(ED)患者C-反应蛋白(CRP)及性功能的作用。方法将60例高血压糖尿病合并IR、ED患者按匹配原则分成两组,常规组30例患者使用钙离子拮抗剂、利尿剂、硝酸酯类制剂、降糖药物等治疗;缬沙坦组30例患者在上述常规治疗基础上,加用缬沙坦80mg/d。评估治疗前和治疗6个月患者的性功能、心率、血压(BP)、腰臀围比(WHR)、空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、C-反应蛋白、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油水平(TG)及国际勃起功能指数(IIEF-5)评分,并进行对照。结果两组患者的降压疗效、ED改善程度和HOMA-IR改善程度间差别均有显著性意义(P<0.01)。治疗前两组患者的IIEF、HOMA-IR、BP、FINS值及CRP、HDL-C、LDL-C、TG、FPG水平间差别均无显著性意义(P>0.05);治疗后两组患者的IIEF、HOMA-IR、BP值及CRP水平间差别有显著性意义(P<0.01),而FINS值及HDL-C、LDL-C、TG、FPG水平间差别均无显著性意义(P>0.05)。相关分析显示:缬沙坦组用药后CRP与HOMA-IR、WHR、LDL-C、FINS呈正相关(r值分别为0.38、0.46、0.51、0.61,P<0.01);IIEF-5与HOMA-IR、WHR、LDL-C、FINS呈负相关(r值分别为-0.43、-0.49、-0.53、-0.58,P<0.01);CRP与HDL-C呈负相关(r值为-0.56,P<0.01);IIEF-5与HDL-C呈正相关(r值为0.48,P<0.01)。结论高血压糖尿病合并IR、ED患者在常规治疗的基础上加用缬沙坦不仅能降压,同时能改善性功能和胰岛素抵抗,降低CRP,升高HDL-C,降低TG及LDL-C水平;对ED患者性功能康复有益处。

Objective To evaluate the effect of losartan on c - reactive protein （CRP） and sexual function in patients with hypertension and diabetes merging insulin resistance （IR） and erectile dysfunction （ED）. Methods According to matching principle, 60 patients with hypertension and diabetes merging IR and ED were divided into 2 groups ： routine group （ n = 30 cases） treated with calcium antagonist, diuretic, nitrate, hypoglycemic agents and etc; losartan group （n=30 cases） given an additional use of losartan besides the above treatment. We evaluated and compared the indexes of sexual function, heart rate, blood pressure （BP） , waist/hip ratio （ WHR）, fasting plasma glucose （ FPG）, fasting insulin （FINS） , HOMA - IR, CRP, high density lipoprotein - cholesterol （ HDL - C）, low density lipoprotein - cholesterol （ LDL - C）, triglyceride level （TG） and international index of erectile function （ IIEF - 5 ） before and after the six - month treatment. Results There was significant difference in effect of depressurization, improvement of ED and HOMA - IR between the two groups （ P 〈0. 01 ） ; No significant difference was noted in value of IIEF, HOMA - IR, BP and FINS and in levels of CRP, HDL - C, LDL - C, TG and FPG between the two groups before the treatment （ P 〉 0. 05 ）. The difference in value of IIEF, HOMA - IR and levels of CRP between the two groups was significant after the treatment （ P 〈 0. 05 ）, while there wasn＇t significant difference in FINS value and levels of HDL - C, LDL - C, TG and FPG between them （ P 〈0. 01 ）. Related analysis showed that CRP had positive correlation with HOMA -IR, WHR, LDL - C and FINS in losartan group after medication （ r = 0.38, 0.46, 0.51, 0.61,P 〈0.01）; IIEF-5 had negative correlation with HOMA - IR, WHR, LDL - C and FINS （r = -0.43, -0.49, -0.53, -0.58, P 〈0. 01） ; CRP had negative correlation with HDL -C （r = -0.56,P 〈0.01）; IIEF-5 had positive correlation with HDL-C （r =0.48,P 〈0.01）. Conclusion Onthebasis of routine treatment, an additional use of losartan can not only lower blood pressure and HOMA - IR in patients with hypertension and diabetes merging IR and ED, but also improve sexual function and insulin resistance, lower CRP, increase HDL - C and decrease TG and LDL - C level ; It is of great benefit to sexual function recovery.