缬沙坦对老年高血压合并2型糖尿病患者C肽水平和颈动脉内膜中层厚度的影响

Effects of Valsartan on Carotid Intima-media Thickness and C Peptide in Elderly Patients with Hypertension and Concomitant Type 2 Diabetes Mellitus

目的 观察缬沙坦和培哚普利对老年高血压合并2型糖尿病患者动脉粥样硬化及胰岛β细胞功能的影响.方法 将54例老年中重度高血压合并2型糖尿病患者随机分为两组.缬沙坦治疗组（V组）26例,每日服缬沙坦1次,80～160 mg;培哚普利组（P组）28例,每日服用培哚普利1次,4～8 mg;疗程均为24个月.测定治疗前后患者动态血压、C肽水平、颈动脉内膜中层厚度（intima-media thickness,IMT）、颈动脉壁结构、24 h尿蛋白定量水平.结果 治疗前两组患者24 h平均血压、颈总动脉IMT、C肽水平及24 h尿白蛋白定量水平差异均无统计学意义（均P＞0.05）,治疗后两组患者24 h平均收缩压较治疗前显著减低（P＜0.05）,V组与P组差异无统计学意义（P＞0.05）.治疗后P组患者颈总动脉IMT（1.19±0.11）mm,V组患者颈总动脉IMT（1.17±0.10）mm,均较治疗前显著减低（均P＜0.05）,两组差异无统计学意义（P＞0.05）.治疗后P组患者空腹C肽水平（1.78±0.38）ng/mL,餐后2 h C肽水平（4.48±1.01）ng/mL,V组患者空腹C肽水平（1.98±0.42） ng/mL,餐后2 h C肽水平（5.22±1.11）ng/mL,均较治疗前有所改善（均P＜0.05）,V组较P组患者C肽水平改善更为显著（P＜0.05）.治疗后两组患者尿白蛋白水平较治疗前均有明显减低（均P＜0.05）,V组较P组患者24 h尿白蛋白降低更为显著（P＜0.05）.结论 缬沙坦及吲哚普利均能有效降低患者血压,改善胰岛功能,改善颈动脉硬化,降低尿白蛋白含量,而缬沙坦对于改善胰岛功能及降低蛋白尿作用略优于吲哚普利.

Objective To examine the effects of valsartan and perindopril on carotid intima-media thickness and islet function in elderly patients with hypertension and concomitant type 2 diabetes mellitus. Methods Fifty-four elderly patients with hypertension and concomitant type 2 diabetes mellitus were randomly divided into valsartan group （80-160 mg/d, n= 26） and perindopril group （4-8 mg/d,n=28）. All patients received treatment for 24 months. Ambulatory blood pressure （Abp）, C- peptide level,intima-media thickness （IMT） of the carotid artery and 24-h urinary protein content were measured before and after treatment. Results There was no significant difference in the 24-h average blood pressure,IMT of the carotid artery,C pipetide level and 24-h urinary protein content between the two groups before the treatment. The 24-h average systolic pressure was significantly decreased after treatment in both groups and there was no difference between the two groups. The IMT of the carotid artery was （1.19±0.11） mm in perindopril group and （1.17 ± 0.10） mm in valsartan group after treatment, both significantly lower than that before treatment （P〈0.05）. No significant difference was found in the IMT of the carotid artery between the two groups. Moreover,the C-peptide level and 24-h urinary protein content were significant improved after treatment in both groups （P〈0.05）. The C-peptide level was significantly higher in valsartan group [fasting C-peptide level （1.98 ±0.42） ng/mL,2-h post-prandial C-peptide level （5.22±1.11） ng/mL]than in perindopril group [fasting C-peptide （1.78±0.38） ng/mL,2-h post-prandial C-peptide level （4.48±1.01） ng/mL]（P〈0.05）. The 24-h urinary protein content was significantly lower in valsartan group than in perindopril group after treatment （P〈0.05）. Conclusion Both valsartan and perindopril can improve the islet function, decrease the blood pressure,IMT of the carotid artery and 24-h urinary protein content of elderly patients with diabetes mellitus and hypertension,and valsartan is more effective than perindopril in improving the islet function and decreasing the 24-h urinary protein.