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目的探讨氯沙坦联合依那普利对老年高血压并发糖尿病患者胰岛素抵抗及内皮功能的影响。方法选择符合标准的原发性高血压并发Ⅱ型糖尿病的患者58例,口服氯沙坦及依那普利治疗12周,分别于用药前后检测血管内皮依赖性舒张功能(EDD)、空腹及餐后2h的血糖、血清胰岛素及C肽、胰岛素敏感指数(ISI)及胰岛素抵抗指数(HOMA-IR)等,并与单纯服用氯沙坦的患者进行比较。结果氯沙坦联合依那普利治疗12周后,患者的收缩压和舒张压,均较单纯氯沙坦治疗组降得更低;EDD较单纯氯沙坦治疗组的改善更为明显;空腹、餐后2h血糖、胰岛素及C肽的水平,均较单纯氯沙坦治疗组降低;空腹、餐后ISI,均较单纯氯沙坦治疗组显著升高,而HOMA-IR则下降。结论氯沙坦联合依那普利治疗较单纯氯沙坦治疗能更有效地降压和改善胰岛素抵抗以及EDD。
Objective To investigate the effects of losartan plus enalapril on insulin resistance and endothelial function in elderly hypertensive patients with diabetes mellitus. Methods Fifty-eight patients with essential hypertension complicated with type II diabetes mellitus were selected and treated with losartan and enalapril for 12 weeks. The levels of endothelium-dependent vasodilation (EDD), fasting and meal 2h after the blood glucose, serum insulin and C-peptide, insulin sensitivity index (ISI) and insulin resistance index (HOMA-IR), and compared with simple losartan patients. Results Losartan combined enalapril treatment for 12 weeks, the patients systolic and diastolic blood pressure were lower than losartan alone treatment group; EDD compared with losartan alone treatment group was more obvious improvement; fasting , Postprandial blood glucose 2h, insulin and C-peptide levels were lower than the losartan treatment group; fasting, postprandial ISI were significantly higher than losartan alone treatment group, while HOMA-IR decreased. Conclusion Losartan combined with enalapril treatment can lower blood pressure and improve insulin resistance and EDD more effectively than losartan alone.