替米沙坦对高血压病患者胰岛素抵抗和左室肥厚的作用

Efiect of telmisartan on left ventricular hypertrophy in patients With diabetes mellitus and hypertension

目的探讨替米沙坦对高血压伴有糖耐量减低患者胰岛素抵抗指数及左室肥厚的影响。方法选择高血压伴有糖尿病以及左室肥厚患者120例,随机分为替米沙坦组(口服1日80～160mg)和贝那普利组(口服1日10～20mg),每组60例,均治疗10个月。治疗前、后检测空腹血糖、血清胰岛素,胰岛素抵抗指数及超声心动图,对比分析治疗前、后上述指标的差异。结果与治疗前比较,替米沙坦组和贝那普利组治疗后收缩压和舒张压明显下降(161/102至135/79mmHg;159/105至138/82mmHg,均为P<0.01);替米沙坦治疗后,空腹血糖、血清胰岛素及胰岛素抵抗指数明显降低〔(8.5±0.9)至(7.2±0.7)mmol.L-1,(11.94±0.9)至(7.1±0.6)pmol.L-1及(5.2±0.5至4.1±0.7),均为P<0.05〕,左室后壁与室间隔厚度显著下降(11.9±0.9)至(7.1±0.6)mm,(4.9±0.5)至(4.2±0.2)mm,均P<0.05〕,左室重量及左室重量指数下降更显著〔(244±91)至(198±75)g.m-2,(152±45)至(118±38)g.m-2,均为P<0.01;贝那普利组治疗后空腹血糖、血清胰岛素、胰岛素抵抗指数无明显的变化,左室后壁与室间隔厚度亦无明显的变化,左室重量及左室重量指数下降显著(251±38)至(228±38)g;(149±51)至(131±45)g.m-2,均为P<0.05〕。结论替米沙坦在提高胰岛素的敏感性、改善糖代谢的同时,使高血压伴有糖尿病患者左室肥厚显著逆转。

OBJECTIVE To explore the effect of angiotensin Ⅱ antagonist on left vent ricular hypert rophy（LVH） and insulin resistance in patients with diabetesmellitus and hypertension.METHODS One hundred and twenty patients with diabetes mellitus andhypertension with LVH by echocardiography entered the study.Patients wererandomized into the telmisartan（80～160mg·d-1） group or benazepril（10～20mg·d-1）group.After treatment of telmisartan or benazepril,patients were followed up for 10 months Plasma sample was collected from each patient before and after treatment of telmisartan or benazepril,respectively.Then plasma levels of FPG,insulinand Homeostasis Model ssessment Insulin Resistance（HOMA2IR）were investigated.The chocardiography before and after 10 months of treatment with telmisartan orbenazepril were also examined.RESULTS Data were analyzed and showed that：①After 10 months of treatment with telmisartan or benazepril,blood pressure wasreduced from 161/102 to 135/79mmHg（P0.01）or from 159/105 to138/82mmHg（P0.01）,respectiveLy.②At the end of 10 months,patients treatedwith telmisartan produced significant improvement in FPG,insulin and HOMA2IRcompared to benazepril group.③Left ventricular mass index decreased from 152g·m-2 to 118g·m-2（P0.01）or from 149 to 131g·m-2（P0.05）respectively.CONCLUSIONS Telmisartan shows a clinically meaningful reduction in the plasmalevels of FPG,insulin,HOMA2IR and LVH.And benazepril is through effects ofblockade of the reninangiotensin system,and activating peroxisomeroliferator 2 activatorsv（PPAR）exert it＇s benefit effect to vatients with diabetesmellitus and hypertension.