黄芪联合替米沙坦对非糖尿病腹膜透析患者胰岛素抵抗的影响研究

Influence of Astragalus Combined With Telmisartan on the Insulin Resistance of Nondiabetic Peritoneal Dialysis Patients

目的探讨黄芪联合替米沙坦对非糖尿病腹膜透析患者胰岛素抵抗的影响。方法选取2012年1月—2014年6月绍兴市人民医院进入持续性不卧床腹膜透析3个月以上,且病情稳定的非糖尿病患者81例,采用随机数字表法分成对照组、替米沙坦组、联合组,各27例。对照组患者给予血管紧张素转化酶抑制剂(ACEI)及血管紧张素Ⅱ受体阻滞剂(ARB)以外的降压药物;替米沙坦组患者给予替米沙坦片80 mg/d,口服;联合组患者给予替米沙坦片基础上加用黄芪颗粒4 g/次,2次/d,口服。均采用Baxter公司生产的1.5%或2.5%葡萄糖透析液进行腹膜透析。记录3组患者性别、年龄、BMI、三酰甘油、总胆固醇水平、腹膜透析时间、腹膜透析液剂量、腹膜透析液糖暴露值、尿量、他汀类药物使用率;分别于治疗0、3、6个月测定血压、血红蛋白(Hb)、超敏C反应蛋白(hs-CRP)、甲状旁腺素(i PTH),计算总尿素清除指数(Kt/V)、内生肌酐清除率(Ccr)及稳态模型胰岛素抵抗指数(HOMA-IR)。结果 3组患者性别、年龄、BMI、三酰甘油、总胆固醇水平、腹膜透析时间、腹膜透析液剂量、腹膜透析液糖暴露值、尿量、他汀类药物使用率比较,差异均无统计学意义(P>0.05)。3组患者收缩压、舒张压、Hb、i PTH、Kt/V、Ccr治疗方法与治疗时间无交互作用(P>0.05);3组间收缩压、舒张压、Hb、i PTH、Kt/V、Ccr比较,差异无统计学意义(P>0.05);不同时间间收缩压、舒张压、Hb、i PTH比较,差异有统计学意义(P<0.05);不同时间间Kt/V、Ccr比较,差异无统计学意义(P>0.05)。3组患者hs-CRP、HOMA-IR治疗方法与治疗时间有交互作用(P<0.05);3组间hs-CRP、HOMA-IR比较,差异有统计学意义(P<0.05);不同时间间hs-CRP、HOMA-IR比较,差异有统计学意义(P<0.05);其中治疗3个月,联合组hs-CRP水平低于对照组,替米沙坦组和联合组HOMA-IR低于对照组(P<0.05);治疗6个月,替米沙坦组和联合组hs-CRP水平、HOMA-IR低于对照组,联合组HOMA-IR低于替米沙坦组(P<0.05)。结论黄芪联合替米沙坦能降低非糖尿病腹膜透析患者的hs-CRP、HOMA-IR,改善患者胰岛素抵抗及微炎症状态。

Objective To investigate the clinical effect of astragalus combined with telmisartan on the insulin resistance of nondiabetic peritoneal dialysis patients. Methods Enrolled 81 nondiabetic patients with stable condition who underwent continuous ambulatory peritoneal dialysis（ CAPD） in Shaoxing People＇ s Hospital for more than three months from January 2012 to June 2014. Using random number table method,the patients were divided into control group,telmisartan group and combined group,with 27 patients in each group. Control group was given antihypertensive drugs apart from ACEI and ARB;telmisartan group was given oral administration of telmisartan tablets by 80 mg / d; combined group was given telmisartan tablets plus the oral administration of astragalus granules by 4 g / time and 2 times / day. All patients were treated with 1. 5% or 2. 5%glucose peritoneal dialysate produced by Baxter. A series of indicators of the three groups were recorded,including age,BMI,triacylglycerol,total cholesterol level, time of peritoneal dialysis, peritoneal dialysis solution dosage, exposure value of peritoneal dialysis solution and urine amount. Blood pressure, Hb, hs- CRP, i PTH, Kt / V, Ccr and HOMA- IR were determined at baseline,3 months and 6 months during treatment. Results The three groups were not significantly different in gender,the usage rate of statins, age, BMI, triacylglycerol, total cholesterol level, time of peritoneal dialysis, peritoneal dialysis dosage,the exposure value of peritoneal dialysis and urine amount（ P〈0. 05）. There was no interaction effect between the treatment methods of systolic pressure,diastolic blood pressure,Hb,i PTH,Kt / V and Ccr and treatment duration（ P〈0. 05）; the three groups were not significantly different in systolic pressure,diastolic pressure,Hb,i PTH,Kt / V and Ccr（ P〈0. 05）; systolic pressure,diastolic pressure,Hb and i PTH changed significantly with different time points（ P〈0. 05）; Kt / V and Ccr changed significantly with different time points（ P〈0. 05）. There was intervention effect between the treatment methods of hs- CRP and HOMA- IR and treatment duration（ P〈0. 05）; the three groups were significantly different in hs- CRP and HOMA- IR（ P〈0. 05）; hs- CRP and HOMA- IR changed significantly with different time points（ P〈0. 05）. 3 months during treatment,combined group was lower（ P〈0. 05） in hs- CRP levels than control group,telmisartan group and combined group was lower（ P〈0. 05） in HOMA- IR than control group. 6 months during treatment,telmisartan group and combined group was lower（ P〈0. 05） in hs- CRP levels and HOMA- IR than control group,combined group was lower（ P〈0. 05） in HOMA- IR than telmisartan group. Conclusion Astragalus combined with telmisartan can reduce the hs- CRP and HOMA- IR of nondiabetic peritoneal dialysis patients and alleviate the insulin resistance and microinflammation.