氯沙坦对糖尿病合并原发性高血压患者内皮细胞功能的影响

Losartan on the vascular endothelial function in diabetes with hypertensive patients

目的观察血管紧张素Ⅱ受体拮抗剂氯沙坦对糖尿病合并高血压患者内皮细胞功能及其分泌因子的影响。方法入选48例糖尿病合并1～2级高血压患者，给予氯沙坦50mg／d治疗4周，如血压未得到控制[收缩压≥140mmHg和（或）舒张压≥90mmHg]，将药物剂量加倍继续治疗4周。采取静脉血测定治疗前、后血浆降钙素基因相关肽（CGRP）、一氧化氮（NO）、前列环素（PGI2）、内皮素（ET）、血管紧张素Ⅱ（AngⅡ）水平及血压的变化。结果31例治疗2周末血压降至正常，收缩压（162．3±23．8）mmHg比（131．5±17．3）mmHg（P〈0．05），舒张压（106．4±14．9）mmHg比（85．3±13．5）mmHg（P〈0．01），其后血压稳定。治疗4周后血浆CGRP和PGI2显著升高，分别为（117．3±19．5）ng／L比（164．2±23．1）ng／L（P〈0．01）和（116．6±69．1）pg／ml比（223．5±84．9）pg／ml（P〈0．01）；血浆AngⅡ水平显著降低[（539．8±226．2）pg／ml比（441．3±161．1）pg／ml，P〈0．05]。其余17例治疗4周后，因收缩压或舒张压未降至正常水平，药量加倍再治疗4周，血压显著下降，收缩压（167．2±21．7）mmHg比（144．2±13．5）mmHg，P〈0．05，舒张压（112．7±13．7）mmHg比（96.3±12．1）mmHg，P〈0．01；血浆CGRP水平显著升高[（112．7±13．7）ng／L比（171．6±37．1）ng／L，P〈0．05]，和健康人水平[（178．1±34．7）ng／L]差异无统计学意义（P〉0．05）。结论氯沙坦是一种安全有效的降压药物，同时可以改善糖尿病合并高血压患者血管内皮细胞功能。

Objective To investigate the effect of losartan on the vascular endothelial function in diabetes with hypertensive patients. Methods Diabetes with mild to moderate hypertensive patients （n=48） were treated with 50 mg/d losartan for 4 weeks, and if the DBP≥90 mm Hg or SBP≥ 140 mm Hg, these patients were treated with 100 mg/d losartan for another 4 weeks. The plasma levels of CGRP, NO ,PGI2, ET,Ang Ⅱ were measured before and after 8 weeks treatment. Results After treated with 50 mg/d losartan for 2 weeks, DBP （106.4±14.9 vs 85.3±13.5,P〈0.01） and SBP （162.3±23.8 vs 131.5±17.3,P〉0.05） of 31 sensitive patients were significantly decreased. After treated for 4 weeks, and plasma levels of CGRP [（117.3±19.5）ng/L vs （164.2±23.1）rig/L, P〈 0.01 ] and PGI2 [ （ 116.6±69.1 ）pg/ml vs （223.5±84.9）pg/ml,P〈0.01 ] were significantly increased; plasma levels of Ang Ⅱ [（539.8±226.2）pg/ml vs （441.3±161.1）pg/ml,P〈0.05] were significantly decreased. As to the patients whose the DBP ≥ 90 mm Hg or SBP ≥ 140 mm Hg after treatment of 50 mg/d for 4 weeks, they were treated with 100 mg/d losartan for another 4 weeks. After double the dose,DBP （112.7±13.7 vs 96.3±12.1 ,P〈0.01） and SBP （167.2±21.7 vs 144.2±13.5,P〈0.05） of 31 sensitive patients were significantly decreased, and plasma levels of CGRP [ （112.7±13.7）ng/L vs （171.6±37.1）ng/L,P〈0.05 ] was significantly increased, with no difference with the normal control group [（178.1±34.7）ng/L,P〉0.05]. Conclusion Eosartan is a safety drug to decrease blood pressure, and to improve the vascular endothelial function for patients with diabetes and hypertension.