对中高危高血压患者葡萄糖耐量试验异常的干预研究

Interventional research of the abnormality of glucose tolerance test in patients with middle to high-risk primary hypertension

目的观察对葡萄糖耐量试验异常的中高危高血压患者进行干预12个月后血压及糖代谢的情况。方法对213例葡萄糖耐量减低(IGT)的高血压患者随机分为生活方式控制组(LC)、生活方式控制加二甲双胍组(LC+M)、生活方式控制加阿卡波糖组(LC+A)三组,分析干预12个月后各组IGT转化为正常葡萄糖耐量(NGT)和新发糖尿病(DM)的发生率以及血压与IGT、NGT、DM之间的关系。结果三组干预12个月后,2hPG均明显降低(P<0.01),与LC组比,LC+M组和LC+A组转为NGT的人数均明显增多(P<0.01),LC+M组和LC+A组相比,在转为NGT和DM的人数方面差异无统计学意义(P>0.05),且血压越达标,糖尿病发生率越低。结论对糖耐量异常的高血压患者,积极的进行干预,可以减少糖尿病的发生,生活方式控制加药物治疗优于单纯生活方式控制。

Objective To observe the change in blood pressure and glucose metabolism in middle to high-risk hypertension patients with impaired glucose tolerance （IGT） after 12--months of intervention. Methods 213 patients with hypertension were randomized into three intervention groups： lifestyle improvement （LI）group, metformin plus LI（MLI） group, and acarbose plus LI（ALI） group. After 12 months of intervention, the converting rate of IGT to normal glucose tolerance （NGT） and the incidence of newly diagnosed diabetes （DM） were investigated, and relationships of blood pressure with IGT, NGT, DM were analyzed. Results All intervention of three groups are effective. The case number of group MLI and ALI converting to NGT were significantly more than that of LC（P〈0. 01）. Compared with group MLI and goup ALI, there were no significant differences in the converted case number of to NGT（P〉 0.05）. And the more standard blood pressure, the lower incidence of diabetes. Conclusions Active intervention can decrease the incidence of diabetes in middle to high-risk hypertension patients with IGT, and addition of life style controlling to drug intervention results in better therapeutic effects.