小剂量胰岛素、葡萄糖持续静脉滴注法测定高血压病胰岛素敏感性

The Insulin Sensitivity in the Patients with Hypertension Tested by the Continuous Low Dose Insulin and Glucose Infusion Test

目的探讨以小剂量胰岛素、葡萄糖持续静脉滴注法测定高血压病患者的胰岛素敏感性及培哚普利对其的影响。方法３６例高血压患者，依糖耐量试验，将其分为单纯高血压组（ＨＴ）与高血压合并糖尿病或糖耐量异常组（ＨＴ＋ＤＭ或ＩＧＴ），以小剂量胰岛素、葡萄糖持续静滴法测定两组胰岛素敏感性差异。患者经服用长效ＡＣＥＩ培哚普利４～８ｍｇ，一日１次，４周后９例完成再次小剂量胰岛素、葡萄糖持续静滴试验，以研究ＡＣＥＩ对胰岛素敏感性的影响。胰岛素敏感性指数（ＩＳＩ）以每血清胰岛素浓度葡萄糖清除率表示。结果ＨＴ＋ＤＭ或ＩＧＴ组胰岛素敏感性指数明显低于ＨＴ组：ＨＴ组ＩＳＩ为１９．６４±１０．８９，ＨＴ＋ＤＭ或ＩＧＴ组：７．７９±４．８９（Ｐ＜０．０１）。服用培哚普利前后ＩＳＩ具统计学显著性差异：治疗前：１４．７２±８．１９；治疗后：１５．３２±８．１８（Ｐ＜０．０１）。结论单纯高血压病患者胰岛素敏感性与高血压合并ＤＭ或ＩＧＴ者具有差异；服用４周培哚普利对胰岛素敏感性有正性作用，进而可能对高血压病患者的心血管系统的重构有逆转作用。然而，尚需对本课题作长期的大样本临床观察。

Aim\ To investigate the insulin sensitivity in the patients with hypertension(HT) and the effect of perindopril by using the continuous low dose insulin and glucose infusion test. Methods\ The patients( n =36) with hypertension were divided into two groups, a simple HT group and complicated diabetes mellitus(DM) or impaired glucose tolerance (IGT) (HT+DM or IGT) according to the oral glucose tolerance test (OGTT). The continuous low dose insulin and glucose infusion test was conducted on the patients to compare the difference of the insulin sensitivity between the two groups. Test was was done again in part of the patients( n =9) after 4 week administration of perindopil 4～8 mg q.d to examine the effect of ACEI on the insulin sensitivity.\ Results\ The indices of insulin sensitivity(ISI), expressed as glucose clearance per serum insulin concentration, were significantly lower in HT+DM or IGT group than that in the HT group (7.79±4.89 vs 19.64±10.89 mg·kg -1 ·min -1 /pmol·L -1 , P <0.01), and the ISI between pre and post administration of Perindopril was significantly different(14.72±8.19 vs 15.32±8.18, P< 0.01).\ Conclusion\ There was a difference between the patients with simple hypertension and hypertension complicated with DM or IGT. And a 4 week oral administration of Perindopril had a positive effect on insulin sensitivity.