探讨开博通抑制双氢克尿噻诱发高血压病人糖代谢异常的不良影响

徐默玲　郑义通　胡世文　徐欣　葛文亮

【摘要】目的 研究开博通能否改善双氢克尿噻(双克)所诱发的高血压病患者糖代谢异常和胰岛素敏感性降低的不良作用。方法 采用随机、前瞻、对比法,将116例原发性高血压病患者随机分成双克组和开博通+双克组。治疗前和治疗后3个月分别检测糖耐量和血清胰岛素浓度(IS)。结果 血糖(GS)在两组治疗后较治疗前均升高(P＜0.05),但开博通组较双克组有下降趋势。IS在双克组治疗后明显升高(P＜0.05)、开博通+双克组明显下降(P＜0.05),两组间比较有显著性差异(P＜0.05)。结论 双克可诱发高血压病患者的糖耐量异常和降低胰岛素敏感性,开博通能较好地改善双氢克尿噻对高血压病患者胰岛素抵抗的不良作用,部分改善双克导致糖代谢紊乱的不良反应。
【关键词】高血压　　开博通　　双氢克尿噻　　糖耐量　　胰岛素

Captropril Can improve hydrochlorothiazide induces abnomality of glucose metabolism in essential hypertension.

Xu Moling,Zheng Yitong,Hu Shiwen,et al.
Secondary Hospital,WuXi,Jiangshu province,214002.

【Abstract】Objectives To determine whether angiotensin-Conventing enzyen inhibition(ACEI),captopril,could improve side effects of abnormal glrcose tolerance and decrease of insulin sensitivity inducde by hydrochlorothiazide in hypertensive patients.Methods Randomised,prepositive,and controled study.116 patients with hypertension were devided into two groups of ACEI+diuretic or diuretic.Plasma glucose(GS)and insulin concentration(IS)were measured before and after treatment of a 3-month peried.Results Aftre treatment GS rose(P＜0.05)in two groups.The GS level in the captopril－treated group was lower than that of the hydrochlorothiazide-treated group.After treatment IS rose in diuretic group but dropped in ACEI group(P＜0.05).Conclusion　Hydrochlorothiazidum can induce GOTT abnormality and derease insulin sensitivity.Captopril can improve partially the side effects which diuretic indaces of abnormalities in glucose metabolism.
【Key words】Hypretrnsion　　Captonpril　　Hydrochlorothiazidum　　Glucose tolerance　　Insulin.

　　高血压病患者易发生糖耐量异常(IGT)和胰岛素抵抗(IR),高血压、IGT、IR都是冠心病的危险因素。好的降压药既要能降低血压,又要减少靶器官损伤的危险因素。双氢克尿噻(双克)因价廉、降压效果肯定,仍为第一线联合常用降压药,但因导致高血压病患者糖耐量异常、胰岛素敏感性(ISI)损害而限制了其临床应用。血管紧张素转换酶抑制剂(ACEI)可改善高血压病患者的ISI,有巯基较无巯基的ACEI在改善ISI上具更好的潜在作用。开博通是唯一具有巯基的ACEI,其改善高血压病患者的糖耐量异常和ISI已得到公认。本文将对开博通能否改善双克的不良反应,作一探讨。

对象和方法
　　一、对象:1995年～1997年来院就诊的未服任
何降压

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