依那普利联合缬沙坦对慢性心力衰竭患者胰岛素抵抗的影响

Effects of enalapril combined with valsartan on insulin resistance in patients with chronic congestive heart failure

目的探讨血管紧张素转换酶抑制剂(ACEI)依那普利与血管紧张素Ⅱ受体拮抗剂(ARB)缬沙坦的联合应用对慢性心力衰竭(CCHF)患者胰岛素抵抗的影响。方法将150例CCHF患者随机分为联合治疗组及对照组,两组患者均给予口服依那普利治疗(5mg/次,1次/d),联合治疗组患者另口服缬沙坦(80mg/次,1次/d),疗程6个月。检测两组患者治疗前、后的空腹血糖(FBG)、空腹胰岛素(FINS)、左心室射血分数(LVEF),并计算稳态模型胰岛素抵抗评估指数(HOMA-IR)及胰岛素敏感指数(ISI)。结果与治疗前比较,两组患者治疗后的FINS、HOMA-IR明显降低,而ISI明显升高(P<0.05)。联合治疗组患者的FINS、HOMA-IR下降幅度及ISI升高幅度明显高于对照组(P<0.05)。对照组与联合治疗组患者治疗后的LVEF分别为(39.5±3.6)%、(41.3±3.5)%,明显高于治疗前[分别为(36.1±3.2)%、(35.9±3.1)%](P<0.05),且治疗后联合治疗组患者LVEF升高幅度高于对照组的LVEF升高幅度(P<0.05)。结论依那普利联合缬沙坦治疗在改善心功能的同时提高胰岛素敏感性,且两药联合应用效果大于单用依那普利。

Objective To explore the effects of combination of angiotensin Ⅱ receptor blocker（ARB） valsartan and angiotensin- converting enzyme inhibitor（ACEI） enalapril on the insulin resistance of patients with chronic congestive heart failure（CCHF）. Methods 150 patients with CCHF were randomly divided into combination treatment group（n=75） and control group（n=75）. Patients in both groups were orally administrated with enalapril （5 mg once daily） ,and valsartan （80 mg once daily） was orally administrated only in patients in combination treatment group. The treatment period was set to 6 months in both groups. Fast blood glueose（FBG） ,fast insulin（FINS）,left ventrieular ejection fraetion（LVEF） of patients in both groups were detected before and after treatment,and the homeostasis model assessment of insulin resistance（HOMA-IR） and insulin sensitivity index（ISI） were calculated. Results Compared with treatment before, FINS and HOMA-IR of patients in both groups significantly decreased while ISI markedly increased after treatment（P〈0.05） ,and the amplitudes of FINS, HOMA-IR decreasing and ISI increasing of patients in combination treatment group were obviously higher than those in control group（P〈0.05）. LVEFs of patients in control group and combination treatment group after treatment were （ 39.5 ± 3.6） %, （41.3 ± 3.5 ） %, respectively, which were significantly higher than those before treatment [ （36.1±3.2） %, （35.9 ±3.1 ）%, respectively] （P〈 0.05）, and the amplitude of LVEF increasing of patients in combination treatment group after treatment was markedly higher than those in control group（P〈0.05）. Conclusion Combined administration of enalapril and valsartan can improve heart function and enhance insulin sensitivity,which reveals greater effects than using enalapril alone.