替米沙坦对老年维持性血液透析患者胰岛素抵抗的影响

Effect of telmisartan on insulin resistance in elderly patients undergoing maintenance hemodialysis

以11例稳定规律透析且近4周未用血管紧张素IIAT1受体阻滞剂或血管紧张素转化酶抑制剂药物的老年血液透析患者为研究对象，逐步换用替米沙坦降压并使血压保持基本稳定，分别于换用替米沙坦降压治疗前及治疗6周和12周时，透析当天空腹抽血检测血生化、空腹血糖和空腹胰岛素，评估胰岛素抵抗指数，并比较治疗前后体重及血压。结果提示替米沙坦治疗后患者体重、高密度脂蛋白、甘油三酯、血肌酐、尿素氮、白蛋白、血钾和甲状旁腺素无明显变化，总胆固醇、低密度脂蛋白有所下降。空腹血糖无明显变化，但空腹胰岛素从（13．9±3．6）mU／ml下降到（9．9±2．7）mU／ml（6周）和（9．1±2．3）mU／ml（12周），均P〈0．01；胰岛素抵抗指数从3．5±1．4下降至2．4±0．8（6周）和2．2±0．8（12周），均P〈0．05。提示替米沙坦可改善老年血液透析患者胰岛素抵抗状态。

Eleven elderly patients undergoing maintenance hemodialysis without ARB or ACEI within 4 weeks were enrolled. Anti-hypertensive agents were replaced by telmisartan gradually to maintain stable blood pressure. Before and after 6 or 12 weeks of treatment, blood biochemical profiles, fasting blood glucose, fasting plasma insulin, insulin resistance index（HOMA-IR）, blood pressure, and body weight were recorded. Our results showed that telmisartan did not affect body weight, high-density lipoprotein （HDL） , triglyceride （TG） , SCr, BUN, Alb, K^＋ , and PTH, although led to a significant decrease in TC and lowdensity lipoprotein （LDL）. Following telmisartan treatment, FPG did not change significantly, but fasting insulin decreased from 13.9 ±3.6 mU/ml to 9. 9±2. 7 or 9. 1 ±2. 3 mU/ml at 6 and 12 week（P 〈0. 01 ）, and HOMA-IR decreased from 3.5 ± 1.4 to 2.4±0. 8 or 2. 2 ± 0. 8 at 6 and 12 week （ P 〈 0. 05 ）. These results suggest that insulin resistance in elderly patients with MHD may be improved by telmisartan.