摘要
目的探索老年纯收缩期高血压（EISH）合并糖尿病治疗选择的相关因素，为临床治疗提供依据。方法采用随机单盲平行对照的方法分析两院2004年11月-2007年10月门诊及住院治疗的124例老年纯收缩期高血压合并2型糖尿病患者的临床资料，并进行统计学分析。结果124例所选病例中，左旋氨氯地平组62例，培哚普利组62例，两组治疗共24wk。两组降压效果比较，左旋氨氯地平组显效40例（64．5％），有效17例（27．4％），无效5例（8．1％），总有效率为91．9％。培哚普利组显效36例（58．1％），有效18例（29％），无效8例（12．9％），总有效率为87．1％。两组间总有效率比较，经Ridit检验，R左旋氨氯地平=0．53，R培哚普利=0．49，差别无显著性（P〉0．05）；两组治疗前后左室肥厚（LVH），血尿酸（UA）、血肌酐（Scr）、血糖（BS）和尿白蛋白排泄量之间差异均有统计学意义，其对治疗结果有影响。结论左旋氨氯地平和培哚普利均能明显地降低老年纯收缩期高血压合并糖尿病患者的收缩压（SBP）。且能逆转LVH及降低UA、Scr、BS和尿白蛋白排泄量，尤以后者为优。
Objective To observe the curative effect of levamlodipine and perindopril on isolated systolic hypertension with type 2 diabetes in the elderly. Methods The 124 clinical cases of isolated systolic hypertension with type 2 diabetes from November 2004 to October 2007 in our hospitals were reviewed . 124 cases were randomly put into levamlodipine group and perindopril group with each group having 62 cases. The course of treatment was 24 weeks. The blood pressure ,heart rate, serum uric acid（UA） ,creatinine（Scr） ,blood sugar（BS） and 24 - hour microalbuminuria excretion were measured before and after treatment . LVID, LVPWT and IVSTD of left ventriculus were detected by echocardio graphy. 36 cases among 124 were performed by 24 -hour ambulatory blood pressure monitoring （ABPM） after wash out and at the end of 22 weeks separately. The clinical data were analyzed statisticly. Results Levamlodipine and perindopril could decrease systolic blood pressure （SBP） in the isolated systolic hypertension with type 2 diabetes in the elderly （ P 〈 0.01 ）. But the results showed no difference between two groups（P 〉0.05）. The results also showed that, in the 55 patients with oral dose of perindopril , SBP, left ventricular hypertorphy（ LVH）, Scr, UA, BS and microalbuminuria excretion were better than those in the older patients with levamlodipine. Conclusions Levamlodipine and perindopril can both decrease Scr, UA, BS and the excretion of microalbuminuria, improve LVH in the isolated systolic hypertension with type 2 diabetes in the eldedy, as well as control blood pressure effectively and steadily, whereas the latter is much better.
