替米沙坦治疗代谢综合征43例临床分析

Clinical analysis of telmisartan for metabolic syndrome

目的探讨替米沙坦对代谢综合征（MS）患者血压、血糖、血脂、炎症因子及尿酸（uA）、尿微量白蛋白（mALB）的影响及其安全性。方法将85例MS患者分为替米沙坦（40mg／d）组和生活干预组，连续治疗6个月，检测治疗前后血压、血糖、血胰岛素、血脂、血清超敏c反应蛋白（hs—CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、UA、尿白蛋白排泄率（UAER）及肝肾功能、血肌酸磷酸激酶（CK）水平。结果治疗6个月后，替米沙坦组与治疗前比较，收缩压、舒张压、空腹血糖、餐后2h血糖、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA—IR）、hs-cRP、TNF—α、IL-6、UA、UAER显著降低（P〈0．05）。生活方式干预组6个月后，血压、血糖、血脂代谢紊乱虽有所改善，但差异未见统计学意义（P〉0．05），hs—CRP、TNF-α、IL-6、UA、UAER略降低，差异未见统计学意义（P〉0．05）。治疗6个月后，替米沙坦组收缩压、舒张压、空腹血糖、餐后2h血糖、FINS、HOMA—IR、hs—CR、TNF—α、IL-6、UA、UAERe低于生活方式干预组（P〈0．05）。结论替米沙坦能改善MS患者的血压、血糖、血脂代谢紊乱、胰岛素抵抗，抑制炎症反应，有效降低UA、UAER水平，安全性好。

Objective To investigate the influence and safety of telmisartan on blood pressure,metabolic disorders of glucose and lipid, inflammatory factors, serum uric acid （UA） and microalbumin- uria（mALB） in patients with metabolic syndrome （MS）. Methods Eighty-five MS patients were enrolled and divided into the telmisartan group with telmisartan 40 mg/d and the life style-intervented group, for 6 months continuously. The levels of blood pressure, blood glucose, fasting insulin （ FINS）, insulin resistance index （ HOMA-IR）, blood lipid, high sensitive C-reactive protein （ hs-CRP）, tumor necrosis factor-α （ TNF-α ）, interleukin-6 （ IL-6 ）, UA, urine albumin excretionrate （ UAER ）, hepatic and renal functions, creatine kinase（CK） were determined for both groups before and after treatment. Results In the telmisartan group, systolic blood pressure（SBP）, diastolic blood pressure（ DBP）, fast- ing plasma glucose（FPG）, 2 h postprandial blood glucose （2hPG）, FINS, HOMA-IR, hs-CRP TNF-α, IL-6, UA and UAER were significantly decreased compared with pretreatment （P 〈 0. 05 ）. After 6-month treatment, in the life style-intervented group, blood pressure, metabolic disorders of glucose and lipid had been improved, but the differences were not significant （P 〉 0. 05 ）. After 6 months hs-CRP, TNF-α, IL-6, UA and UAER were also slightly reduced, but difference was not significant （ P 〉 0.05 ）. SBP, DBP, FPG, 2 hPG, FINS, HOMA-IR, hs-CRP, TNF-α, IL-6, UA and UAER in the telmisartan group were significant lower than those in life style-intervented group after 6 months follow-up （P 〈 0. 05）. Conclusions Telmisartan can not only improve blood pressure, metabolic disorders of blood glucose and lipid, improve insulin resistance, but also can inhibit inflammation in MS patients and reduce the levels of UA and UAER. It does not cause serious adverse events, and its security is good.