氯沙坦钾对高血压伴糖尿病患者hs-CRP、NO及内皮素-1的影响

Effect of losartan potassium on serum hs-CRP, NO and ET-1 in the treatment of hypertension with T2DM

目的探讨氯沙坦钾对高血压伴2型糖尿病(T2DM)患者超敏C反应蛋白(hs-CRP)、一氧化氮(NO)以及内皮素-1(ET-1)水平的影响。方法选取2014年10月至2016年5月东莞市虎门医院心血管内科收治的86例高血压伴T2DM患者,根据随机数表法分为观察组和对照组,每组43例。所有患者均予低盐、高蛋白饮食,口服降糖药或皮下注射胰岛素控制血糖约7.0 mmol/L,对照组同时给予氨氯地平(5.0 mg/次,1次/d)晨服,观察组予氯沙坦钾(50 mg/次,1次/d)晨服,疗程均为12周。治疗前后检测两组患者的血糖与血压、炎症因子、氧化应激、血管内皮细胞功能以及肾功能,并比较治疗效果。结果治疗后,对照组与观察组患者的收缩压(SBP)[(136.36±17.05)mm Hg vs(121.28±14.68)mm Hg]、舒张压(DBP)[(78.34±9.18)mm Hg vs(68.19±8.22)mm Hg]、hs-CRP[(3.52±0.46)mg/L_(vs)(2.60±0.32)mg/L]、白细胞介素6(IL-6)[(72.67±10.21)ng/L_(vs)(53.24±7.27)ng/L]、肿瘤坏死因子α(TNF-α)[(112.57±15.06)mg/L_(vs)(93.36±11.71)mg/L]、超氧化物歧化酶(SOD)[(74.38±10.36)U/m L_(vs)(98.69±13.52)U/m L]、NO[(67.37±9.40)mol/L_(vs)(77.18±10.52)mol/L]、血清丙二醛(MDA)[(5.09±0.64)mol/L_(vs)(4.00±0.44)mol/L]、降钙素基因相关肽(CGRP)[(154.06±20.16)ng/L_(vs)(171.34±22.72)ng/L]、ET-1[(54.28±7.23)ng/L_(vs)(42.91±5.86)ng/L]、血管紧张素Ⅱ(AngⅡ)[(440.68±61.38)pg/m L_(vs)(406.38±52.46)pg/m L]比较差异均有统计学意义(P<0.05);观察组患者的治疗总有效率为90.70%,明显高于对照组的79.07%,差异有统计学意义(P<0.05)。结论氯沙坦钾治疗高血压伴T2DM效果显著,其可有效减轻患者的炎症反应及氧化应激,明显改善血管内皮功能,更有效保护肾功能。

Objective To investigate the effect of losartan potassium on serum high-sensitivity C-reactive protein（hs-CRP）, nitric oxide（NO） and endothelin 1（ET-1） in the treatment of hypertension（HT） with T2 DM.Methods A total of 86 patients with HT and T2 DM, who admitted to Department of Cardiology of Dongguan Humen Hospital from October 2014 to May 2016, were selected and divided into the observation group and control group according to random number table, with 43 patients each group. All patients were treated with low salt and high protein diet, oral hypoglycemic agents or subcutaneous injection of insulin to control blood sugar under 7.0 mmol/L. The control group additionally received amlodipine（5.0 mg/time, qd）, and the observation group received losartan（50 mg/time, qd）,both for 12 weeks. The blood glucose, blood pressure, inflammatory factors, oxidative stress, vascular endothelial cell function and renal function before and after the treatment were detected, and the therapeutic effects were compared.Results After the treatment, the levels of systolic blood pressure（SBP）, diastolic blood pressure（DBP）, hs-CRP, interleukin-6（IL-6）, tumor necrosis factor-α（TNF-α）, superoxide dismutase（SOD）, NO, malondialdehyde（MDA）, calcitonin gene-related peptide（CGRP）, ET-1, angiotensin Ⅱ（Ang Ⅱ） of the control group were respectively（136.36±17.05） mm Hg,（78.34±9.18） mm Hg,（3.52±0.46） mg/L,（72.67±10.21） ng/L,（112.57±15.06） mg/L,（74.38±10.36） U/m L,（67.37±9.40） mol/L,（5.09±0.64） mol/L,（154.06±20.16） ng/L,（54.28±7.23） ng/L,（440.68±61.38） pg/m L versus corresponding（121.28 ± 14.68） mm Hg,（68.19 ± 8.22） mm Hg,（2.60 ± 0.32） mg/L,（53.24 ± 7.27） ng/L,（93.36 ± 11.71） mg/L,（98.69 ± 13.52） U/m L,（77.18 ± 10.52） mol/L,（4.00 ± 0.44） mol/L,（171.34 ± 22.72） ng/L,（42.91 ± 5.86） ng/L,（406.38 ±52.46） pg/m L in the control group（All P〈0.05）, The total effective rate in the observation group was 90.70%, which was significantly higher than 79.07% in the control group（P〈0.05）. Conclusion Losartan potassium is effective in the treatment of patients with HT and T2 DM, which can effectively reduce the inflammatory reaction and oxidative stress, significantly improve the vascular endothelial function and protect renal function effectively.