双氢克尿噻长期使用对高血压病患者糖代谢的影响

The long term effect of Dihydrochlorothiazide on glucose metabolism of patients with primary hypertension

为观察双氢克尿噻（ＤＨＣＴ）长期使用后对高血压病患者糖代谢的影响，我们给２５例轻度高血压病患者口服ＤＨＣＴ１２．５ｍｇ，每ｄ两次，持续观察３年时间，每隔１年检查空腹及餐后２ｈ血糖和空腹及餐后２ｈ血清胰岛素水平，并同时测定血清Ｋ＋、血清总胆固醇（ＴＣ）及血清总甘油三脂（ＴＧ）。每隔两周观察１次血压变化情况。结果发现ＤＨＣＴ的近期及远期降压效果均较理想，２０／２５的患者血压控制在正常范围。并发现口服ＤＨＣＴ１年后高血压病患者的血糖及血清胰岛素水平均较治疗前显著升高（Ｐ＜０．０５）。说明长期使用ＤＨＣＴ确能升高高血压病患者的血糖水平、降低糖耐量和降低其对胰岛素的敏感性。但继续治疗并未发现血糖及胰岛素水平的进一步升高，也未发现糖尿病的临床表现。观察过程中未发现血清Ｋ＋、血清ＴＣ及ＴＧ有显著性改变。认为使用小剂量ＤＨＣＴ是一种长期。

To investigate the long term effect of Dihydrochlorothiazide(DHCT) on glucose metabolism, we treated 25 patients with primary hypertension using DHCT(12.5 mg) twice daily for 3 years. Every other year, the blood glucose and serum insulin levels were measured after fasting and two hours post prandial, and the serum potassium, cholesteral, triglyceride were also measured at the same time. The results indicate that DHCT has both short term and long term effects of lowering blood pressure, and 20/25 patients′ blood pressure were controlled in normal range. The glucose level and serum insulin level were significantly elevated( P <0.05) after 1 year′s treatment with oral DHCT, but no further elevation was observed after 2 and 3 years′ treatment. There were no significant changes of serum potassium, cholesteral and triglyceride. No patients developed clinical significant dibetes mellites. These results suggest that using low dose of DHCT is an effective safe and long term antihypertensive therapy.