缬沙坦和胰激肽原酶联用改善高血压胰岛素抵抗的研究

Comparative Research between Valsartan Combined with Pancreatic Kininogenase and Insulin Resistance in Essential Hypertension

目的:观察缬沙坦联用胰激肽原酶对改善高血压胰岛素抵抗的作用是否优于贝那普利。方法:128例伴有空腹胰岛素增高的轻中度高血压病患者随机分为贝那普利组、缬沙坦组、贝那普利+胰激肽原酶组、缬沙坦+胰激肽原酶组4个治疗组。另设对照组30例。随访期4个月。治疗前后测定体质量指数(BMI)、血压、空腹及餐后2h血糖和胰岛素、胰岛素敏感指数(ISI),进行治疗前后及组间比较。结果:治疗前后各治疗组血压水平及BMI相似。与对照组相比,各治疗组治疗前空腹及餐后2h血糖和空腹胰岛素均显著升高(P<0.01),ISI显著降低(P<0.01),治疗后这些指标均显著改善(P<0.05或P<0.01),其中缬沙坦+胰激肽原酶组改善幅度最为明显(P<0.01),显著优于其他各组(P<0.05或P<0.01)。结论:缬沙坦联用胰激肽原酶改善胰岛素抵抗的作用显著优于贝那普利或贝那普利和胰激肽原酶联用。

Objective： To observe the effect of valsartan combined with pancreatic kininogenase on insulin resistance in essential hypertension. Methods： One hundred and twenty eight mild to moderate hypertensive patients with fasting hyper-insulinemia were randomly divided into 4 groups, group benazepril （group B）, group valsartan （group V）, group benazepril ＋ pancreatic kininogenase（group B＋K） and group valsartan ＋ pancreatic kininogenase （group V＋K）. The control group consisted of 30 healthy subjects （Group N）. The treatment lasted 4 months. The values of body mass index （BMI）,blood pressure,fasting and 2 hours postprandial blood glucose （FBG and 2 h PBG） and serum insulin （FINS and 2 h INS） were detected respectively and insulin-sensitivity index （ISI） was calculated on the first and last day of the treatment. Then the therapeutical effects were evaluated. Results： The levels of patients＇ blood pressure and BMIs were similar before and after treatment among the four treated groups. The levels of FBG, 2 h PBG, FINS and 2 h INS significantly increased （P 〈 0.01 ）, whereas ISI significantly decreased （P 〈 0.01 ）, before treatment compared with those of control subjects. These parameters were improved significantly after treatment （P 〈 0.05 or P 〈 0.01 ）. The improved extents of these parameters were most significant in group V＋K （P 〈 0.01 ） compared to those of other treated groups （P 〈 0.05 or P 〈 0.01 ）. Conclusion： The effect of valsartan combined with pancreatic kininogenase on insulin resistance is much better than that of benazepril or benazepril combined with pancreatic kininogenase.