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替米沙坦对肥胖高血压患者胰岛素抵抗和血清视黄醇结合蛋白4水平的影响

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2011年第1期
页码:
77-79
栏目:
临床研究
出版日期:
2010-10-27

文章信息/Info

Title:
Effects of telmisartan on insulin resistance and serum retinol-binding protein 4 in patients with essential hypertension
作者:
黄高忠; 张蓓; 胡挺军; 张莉; 王蓓芸; 章晓燕; 钟远
上海交通大学附属第六人民医院老年科，上海 200233
Author(s):
HUANG Gao-zhong;  ZHANG Bei;  HU Ting-jun;  ZHANG Li;  WANG Bei-yun;  ZHANG Xiao-yan;  ZHONG Yuan
Department of Geriatrics, Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai 200233, China
关键词:
高血压; 胰岛素抵抗; 替米沙坦; 视黄醇结合蛋白4
Keywords:
hypertension;  insulin resistance;  telmisartan;  retinol-binding protein 4
分类号:
R972.4
DOI:
-
文献标识码:
A
摘要:
目的: 观察替米沙坦对伴超重或肥胖的高血压患者血压、糖脂代谢指标和血清视黄醇结合蛋白4（RBP4）水平的影响。方法： 将45例门诊超重或肥胖的原发性高血压患者随机分为替米沙坦组(n=23)和氯沙坦组(n=22)，分别给予替米沙坦80 mg(qd)或氯沙坦100 mg(qd)，必要时加用长效钙拮抗剂，治疗16周。观察用药前后腰围、腰臀比、体质量指数、血压、空腹血糖、胰岛素、血脂和血清RBP4含量的变化。采用稳态模式法计算胰岛素抵抗指数（HOMA-IR）。结果： 两组治疗后，收缩压及舒张压与治疗前比较均明显下降，替米沙坦组分别降低20.5 mmHg和14.8mmHg，氯沙坦组分别降低18.3 mmH和14.2 mmHg，下降幅度组间比较无差异；替米沙坦组HOMA-IR和血清RBP4的含量明显下降，分别由7.24±1.82下降至6.02±2.16（P<0.05）和(46.9±15.0)mg/L下降至(39.8±14.8)mg/L（P<0.05）。结论： 替米沙坦可改善肥胖伴高血压患者的胰岛素敏感性、降低血清RBP4的水平。
Abstract:
AIM: To investigate the effects of telmisartan on insulin resistance and serum retinol-binding protein 4 in patients with essential hypertension. METHODS: Forty-five subjects with essential hypertension were treated with telmisartan (80 mg/day) or losartan (100 mg/day) combined with long-acting calcium antagonist, if necessary, for 16 weeks. Waist and hip circumference, body mass index, blood pressure, fasting plasma glucose (FPG), insulin (FPI), lipid and retinol-binding protein 4 (RBP4) were measured before and after the treatment. Insulin sensitivity was estimated by homeostasis model assessment (HOMA-IR). RESULTS: Compared with baseline levels, systolic and diastolic blood pressure decreased significantly in both groups. But the levels of HOMA-IR and RBP4 decreased significantly only in telmisartan group. CONCLUSION: Telmisartan improves insulin resistance and decreases serum RBP4 level in patients with essential hypertension.

参考文献/References

[1]Yang Q, Graham TE, Mody N, et al. Serum retinol binding protein 4 contributes to insulin resistance in obesity and type 2 diabetes[J]. Nature, 2005, 436(7049):356-362.

[2]Xu M, Li XY, Wang JG, et al. Retinol-binding protein 4 is associated with impaired glucose regulation and microalbuminuria in a Chinese population[J]. Diabetologia, 2009, 52(8):1511-1519.

[3]Benson SC, Pershadsingh HA, Ho CI, et al. Identification of telmisartan as a unique angiotensin II receptor antagonist with selective PPARγ-modulating activity[J]. Hypertention, 2004, 43(5):993-1002.

[4]贾伟平，项坤三，陈蕾，等. 上海地区40岁以上自然人群中胰岛素抵抗现况及特征分析[J]. 上海医学， 2001， 24(4):199-201.

[5]Scheen AJ. Prevention of type 2 diabetes mellitus through inhibition of the Renin-Angiotensin system[J]. Drugs, 2004, 64(22):2537-2565.

[6]Vitale C, Mercuro G, Castiglioni C, et al. Metabolic effect of telmisartan and losartan in hypertensive patients with metabolic syndrome[J]. Cardiovasc Diabetol, 2005,4:6.

[7]Yamada S, Ano N, Toda K, et al. Telmisartan but not candesartan affects adiponectin expression in vivo and in vitro[J]. Hypertens Res, 2008, 1(4):601-606.

[8]Ueshiba H, Miyachi Y. Effects of the long-acting calcium channel blockers，amlodipine，manidipine and cilnidipine on steroid hormones and insulin resistance in hypertensive obese patients[J]. Intern Med, 2004, 43(7)：561-565.

[9]包玉倩，吴海娅，邱慧玲，等. 罗格列酮对2型糖尿病患者血清视黄醇结合蛋白4水平及肝脏脂肪含量的影响[J]. 上海医学, 2008, 31(11):767-770.

[10]Yusuf S, Diener HC, Sacco RL, et al. Telmisartan to prevent recurrent stroke and cardiovascular events[J]. N Engl J Med, 2008, 359(12):1225-1237.

备注/Memo

备注/Memo:
收稿日期：2010-01-05.基金项目：上海交通大学医学院科技基金项目资助（0224630151） 通讯作者：黄高忠，主任医师，主要从事老年心脑血管病的研究 Email:huanggaozhong@medmail.com.cn
更新日期/Last Update: 2010-10-27