奥美沙坦酯对冠心病并发糖尿病患者血管内皮细胞功能的影响

Effect of olmesartan on the function of vascular endothelial cells in patients with coronary heart disease complicated with diabetes mellitus

目的探讨奥美沙坦酯对冠状动脉粥样硬化性心脏病(冠心病)并发糖尿病患者血管内皮细胞功能的影响。方法选取符合条件的126例冠心病患者作为试验组。依据血糖浓度分为3组:单纯冠心病组(C,n=42);冠心病并发糖耐量异常组(CA,n=42);冠心病并发糖尿病组(CD,n=42)。每组均依据随机数字法均分为A、B两亚组,A亚组给予常规方法治疗;B亚组在A亚组的基础上给予奥美沙坦酯40 mg/d口服进行治疗。治疗后3个月,对比各组血管内皮细胞功能指标变化。结果 (1)药物治疗前,CA组、CD组的一氧化氮浓度均显著高于C组,差异有统计学意义(均P<0.05);CA组、CD组内皮素-1浓度显著低于C组,差异有统计学意义(P<0.05,P<0.01)。(2)药物治疗后,CA-A亚组、CD-A亚组的一氧化氮浓度较药物治疗前显著升高,差异有统计学意义(均P<0.05);而内皮素-1浓度较用药前均显著降低,差异有统计学意义(均P<0.05)。(3)药物治疗前,CA组、CD组的外周血内皮祖细胞(endothelial progenitor cell,EPC)数量均显著低于C组,差异有统计学意义(均P<0.05);药物治疗后,CA-A亚组、CD-A亚组的EPC数量较用药前显著升高,差异有统计学意义(均P<0.05)。结论冠心病患者并发糖尿病或糖耐量异常会加重血管内皮的损害。奥美沙坦酯可有效提高高血糖冠心病患者外周血EPC数量,能够抑制血管内皮舒缩因子,具有血管内皮保护作用。

Objectives To investigate the effects of olmesartan decanone on the function of vascular endothelial cells in patients with coronary heart disease complicated with diabetes mellitus. Methods A total of 126 patients with coro-nary heart disease were selected as the test group. According to the blood glucose concentration ,they were divided into three groups：simple coronary heart disease group（C,n=42）;coronary heart disease with impaired glucose tolerance group（CA,n =42）;coronary heart disease with diabetes group（CD,n=42）. Each group was divided into A and B subgroups according to the random number method. Patients in A subgroup were given routine treatment and patients in B subgroup received oral administration of olmesartan palmitate 40 mg/d on the base treatment of A subgroup. After treatment for 3 months,functional indexes of vascular endothelial cells in each group were compared. Results （1）Before drug treatment,concentrations of nitric oxide in CA group and CD group were significantly higher than that in C group （P〈0.05）;concentrations of endothelin-1 in CA group and CD group were significantly lower than that in C group（P〈0.05,P〈0.01）. （2）After drug treatment,concentrations of nitric oxide in CA-A subgroup and CD-A subgroup were significantly higher than those before drug treatment（P〈0.05）,while concentrations of endothelin-1 were significantly lower than those before treatment（P〈0.05）. （3）Before drug treatment,numbers of endothelial progenitor cell（EPC） in peripheral blood of CA group and CD group were significantly lower than that of C group （all P〈0.05）;After drug treatment,numbers of EPC in CA-A subgroup and CD-A subgroup were significantly higher than those before treat-ment （all P〈0.05）. Conclusions Coronary heart disease patients with diabetes or impaired glucose tolerance willincrease the damage of vascular endothelium. Omeansartan ester can effectively improve the number of peripheral blood EPC in patients with hyperglycemia and coronary heart disease ,which can inhibit the endothelium systolic and diastolic factors and have the protective effect of vascular endothelium.