高血压病患者胰岛素抵抗及药物干预的观察

Clinical observation of insulin resistance and drug intervention in essential hypertensive patients.

对26例高血压病(EH)患者用口服葡萄糖进行糖耐量试验(OGTT)及胰岛素(IS)释放试验。结果显示EH患者糖耐量普遍减低,存在胰岛素抵抗(IR)和高胰岛素血症(HIS)。EH患者舒张压(DBP)与血胰岛素(IS)水平显著正相关,P值分别<0.01,<0.05;收缩压(SBP)与血IS水平部分呈正相关。降压治疗8周后,硝苯吡啶组(Ⅰ)血糖(GS)无明显改变。糖负荷后60min、120min血IS水平及IS释放曲线下面积〔AVC〕I降低,P<0.05;巯甲丙脯酸组(Ⅱ)GS、糖耐量曲线下面积〔AUC〕G及血IS释放曲线下面积〔AUC〕I,IS/GS比值均较治疗前明显降低,P值分别<0.05,<0.01,表明巯甲丙脯酸有明显的改善胰岛素敏感性及糖代谢效应。机制与其增加骨骼肌血流,抑制肾素血管紧张素系统,减慢缓激肽的释放有关。硝苯吡啶对EH患者血糖无明显影响,对血IS水平影响有待进一步探讨。

The purpose of this paper is to determine the change of glucose metabolism in essential hypertensive patients before and after thetreatment with the drug of the captopril or nifedipine. During the oral glucose tolerance test (OGTT) and the insulin release test (IRT),the levels of the serum glucose (GS) and serum insulin (IS) were measured, IS/GS ratio,the insulin resistance(ISR),the area under the curve of the OGTT(AUCg) and the area under the curve of the IST(AUCi) were calculated. The results showed that there were ISR hyperinsulinemia and decreased glucose tolerance in essential hypertenseve patients, The diastolic blood pressure was positively correlated to the IS levels(P<0. 05) and the systolic blood pressure was positively correlated to the IS levels partially. After eight-week treatment, GS, IS, IS/GS ratio, AUCi and AUCg were significantly reduced in the captopril group(P<0. 05) ;whereas,in the nifedipine group there was not significantly changed in GS, and IS, AUCi were significantly decreased at 60,120 minutes in OGTT. Et suggested that the drug of the captopril be able to reduqe ISR, improve the sensitivity of the insulin and regulate the glucose metabolism;but the drug of the nifedipine unable to do.