依那普利叶酸片对H型高血压合并糖尿病患者血压和血糖水平的影响

Influence of enalapril folic acid tablet on blood pressure and blood glucose levels in patients with H-type hypertension complicated diabetes mellitus

目的:观察马来酸依那普利叶酸片对H型高血压合并糖尿病(DM)患者的血压及血糖水平的影响。方法:选择300例H型高血压合并DM患者,根据随机数字表法随机均分为依那普利组、氨氯地平组及依那普利叶酸组。治疗前、后1、12和24个月,分别测量并比较三组血压、血浆同型半胱氨酸(Hcy)、颈动脉内膜中层厚度(CIMT)、空腹血糖(FPG)、餐后2h血糖(2hPG)、空腹胰岛素(FINS)、餐后2h胰岛素(2hPINS)。随访2年,比较三组脑血管事件和心血管事件发生率。结果:与依那普利组和氨氯地平组比较,治疗24个月后,依那普利叶酸组SBP[(134.65±7.25)mmHg,(136.00±8.62)mmHg比(128.62±5.00)mmHg]、DBP[(84.79±4.26)mmHg,(88.47±7.25)mmHg比(74.29±5.06)mmHg]、血浆Hcy[(11.18±5.21)μmol/L,(30.29±5.62)μmol/L比(9.72±2.47)μmol/L]、CIMT[(1.30±0.19)mm,(1.46±0.37)mm比(0.95±0.38)mm]、2hPG[(12.50±1.70)mmol/L,(12.90±1.90)mmol/L比(9.50±1.00)mmol/L]、2hPINS水平[(71.38±17.63)μU/ml,(78.42±21.49)μU/ml比(61.28±18.14)μU/ml]均显著降低,P<0.05或<0.01。随访两年发现,与依那普利组和氨氯地平组比较,依那普利叶酸组治疗24个月时脑血管事件(11%,23%比0)和心血管事件发生率(2%,11%比0)显著降低,P均<0.01。结论:依那普利叶酸片能显著降低H型高血压合并糖尿病患者血压、血糖和Hcy水平,有效减缓动脉粥样硬化进展,安全性好,值得推广。

Objective： To observe influence of enalapril maleate and folic acid tablet （EFA） on blood pressure and blood glucose levels in patients with H-type hypertension （HTH） complicated diabetes mellitus （DM）. Methods： According to random number table, a total of 300 HTH ± DM patients were equally divided into enalapril group, amlodipine group and EFA group. Levels of blood pressure, plasma homocysteine （Hcy）, carotid intima-media thickness （CIMT）, fasting plasma glucose （FPG）, 2h postprandial glucose （2hPG）, fasting insulin （FINS）, 2h postprandial insulin （2hPINS） were measured and compared among three groups before, and one, 12 and 24 months after treatment. All patients were followed up for two years, incidence rates of cardiovascular and cerebrovascular events were compared among three groups. Results： Compared with enalapril group and amlodipine group on 24 months after treatment, there were significant reductions in levels of SBP [ （134. 65 ± 7.25） mmHg, （136.00 ± 8.62） mmHg vs. （128. 62±5.00） mmHg], DBP [ （84.79±4.26） mmHg, （88.47±7.25） mmHgvs. （74.29±5.06） mmHg], plasma Hcy E （11.18 ± 5.21） μmol/L , （30.29 ± 5.62） μmol/L vs. （9.72 ± 2.47） μmol/L], CIMT [ （1.30 ± 0.19） ram, （1.46±0.37） mmvs. （0.95±0.38） mm], 2hPG [ （12.50±1.70） mmol/L, （12.90±1.90） mmol/L vs. （9.50 ± 1.00） mmol/L] and 2hPINS [ （71.38 ± 17. 63） μU/ml, （78.42 ± 21.49） μU/ml vs. （61.28± 18.14）μU/ml], P〈0.05 or 〈0.01. After two-year follow-up, compared with enalapril group and amlodipine group on 24 months after treatment, there was significant reductions in incidence rates of cerebrovascular events （11%, 23 % vs. 0） and cardiovascular events （2%, 11% vs. 0） in EFA group, P〈0.01 all. Conelusiom EFA tablets can significantly reduce blood pressure, blood glucose and Hcy level and effectively delay atherosclerosis progression in HTH ＋ DM patients, its safety is good, which is worth extending.