氯沙坦对血液透析患者大动脉僵硬度的影响及机制

Effect of losartan on aortic stiffness in hemodialysis patients

目的观察血管紧张素Ⅱ受体拮抗剂氯沙坦对血液透析患者大动脉僵硬度的影响,并探讨其机制。方法将72例血液透析患者随机分为氯沙坦组和比索洛尔组各36例。氯沙坦组口服氯沙坦50 mg,1次/d,比索洛尔组口服比索洛尔5 mg,1次/d。治疗前、治疗12个月(治疗后)测定两组家庭血压(Home-SBP)、主动脉脉搏波传导速度(PWV)、颈动脉内中膜厚度(IMT)、内中膜横断面积(IMCSA)、血清氧化型低密度脂蛋白(ox-LDL)、胰岛素抵抗指数(HOMA-IR)。结果治疗后两组Home-SBP比较,差异无统计学意义(P>0.05)。与治疗前比较,两组治疗后PWV均明显降低,氯沙坦组降幅大于比索洛尔组(P均<0.05)。氯沙坦组治疗后IMT无明显变化(P>0.05),IMCSA明显减小(P<0.01);比索洛尔组IMT明显增厚(P<0.01),IMCSA无明显改变(P>0.05)。氯沙坦组治疗后ox-LDL、HOMA-IR均明显降低(P均<0.01),而比索洛尔组二者无明显改变(P均>0.05)。结论氯沙坦能显著降低血液透析患者大动脉僵硬度,其机制可能独立于降压作用,与降低氧化应激、改善胰岛素抵抗、减轻管壁肥厚相关。

Objective To investigate the effect of the angiotensin U receptor blocker losartan on arterial stiffness in hemodialysis patents and its mechanism. Methods Seventy-two hemodialysis patients were randomly assigned to receive either 50 mg losartan, qd （n = 36, losartan group） or 5 mg 13-blocker bisoprolol, qd （ n = 36, bisoprolol group）. The home blood pressure （Home-BP）, aortic pulse wave velocity （PWV）, common carotid artery intima-media thickness （IMT）, intima-media cross sectional area （IMCSA）, serum oxidized low density lipoprotein （ox-LDL） and homeostasis model assessment index of insulin resistance （HOMA-IR） were determined before treatment and 12 months after treatment. Results After treatment, no significant difference was found in Home-BP between the two groups （P 〉 0.05 ）. Compared with that before treatment, PWV was decreased in both groups, and the reduction was more significant in the losartan group than that in the bisoprolol group （ all P 〈 0.05 ）. No change in IMT was observed （ P 〉 0.05 ）, and IMCSA was significantly decreased in the losartan group after treatment （ P 〈 0.01 ）. On the contrary, no change was found in IMCSA （ P 〉 0.05 ）, but IMT was significantly increased in the bisoprolol group （P 〈 0.01 ）. In the losartan group, serum ox-LDL and HOMA-IR were significantly decreased （ all P 〈 0.01 ）, but they had no significant change in the bisoprolol group （ all P 〉 0.05）. Conclusions Arterial stiffness was significantly attenuated by treatment with losartan in hemodialysis patients, and the effect might be independent of blood pressure reduction, but related to decreasing oxidative stress, improving insulin resistance and reducing artery hypertrophy.