调糖、调脂对高血压伴胰岛素抵抗患者脂蛋白(a)水平治疗对比

Effect of glycemic control and lipid-lowering treatment on the level of lipoprotein(a) in patients with hypertension and insulin resistance.

目的对比基础治疗下调糖、调糖对高血压伴胰岛素抵抗(IR)患者脂蛋白(a)水平的影响。方法 102例轻中度高血压伴胰岛素抵抗患者,分别给予基础治疗及常规降压加辛伐他汀治疗和常规降压加二甲双胍治疗,观察两组患者治疗前后12周的血压、血脂三项、胰岛素抵抗指数、体质指数、高Lp(a)人数等相关数据。结果常规降压加调脂或调糖治疗,能使轻中度高血压伴胰岛素抵抗(IR)患者血压、血甘油三脂降低(P<0.05);胰岛素抵抗指数明显改善(P<0.05);高Lp(a)人数明显减少(P<0.001),二甲双胍组由于使体质指数降低(P<0.01),高Lp(a)人数减少更多(P<0.05)。结论高Lp(a)与高血压伴胰岛素抵抗密切相关,它们可能共同参与动脉粥样硬化过程,降压、调脂、调糖可改善血压、血脂降低、胰岛素抵抗、高Lp(a)水平情况,二甲双胍组由于降低患者BMI,使高Lp(a)水平下降更明显。

Objective To compare with basic therapy, effect ofglycemic control and lipid-lowering treatment on levels of lipoprotein（a） in patients with hypertension and insulin resistance. Methods 102 patients with mild to moderate hypertension and insulin resistance were given basic therapy and routine anti-hypertensive with simvastatin; or routine anti-hypertensive with metformin. The blood pressure, lipid profile, insulin resistance index, body mass index, number of patients with high Lp（a） level and related data were observed before and 12 weeks after treatment in the two groups. Results Routine anti-hypertensive with lipid-lowering agents or hypogIycemic agents reduced the blood pressure, triglyceride level in patients with mild to moderate hypertension and insulin resistance （P〈0.05）. As mefformin reduced the body mass index （P〈0.001）, and the number of patients with high level of Lp（a） further reduced （P〈0.05）. Conclusion High Lp（a） level is closely related to hypertension with insulin resistance. They may contribute to the process of atherosclerosis together. Anti-hypertensive, lipid-lowering agents and glycemic control can improve the blood pressure, lipid profile, insulin resistance and the high Lp（a）. As metformin can lower the BMI of patients, the reduction of Lp（a） is even more significant.