血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂改善2型糖尿病合并动脉粥样硬化患者血管内皮功能近期疗效的对比研究

摘要/Abstract

摘要： 目的比较血管紧张素转换酶抑制剂(ACEI)雷米普利5mg和血管紧张素受体拮抗剂(ARB)伊贝沙坦150mg治疗2型糖尿病合并动脉粥样硬化(AS)患者的肱动脉内皮功能的变化。方法确诊的2型糖尿病合并AS患者用完全随机开放非均衡设计,将患者分为ACEI组99例,雷米普利开始剂量2.5mg/d,逐渐加至5mg/d;ARB组25例,用伊贝沙坦逐渐加量至150mg/d;对照组21例,不用以上药物。疗程3个月以上。血管B超检查患者治疗前后肱动脉内皮功能的变化。随访3个月。结果与结论 ACEI组患者治疗后肱动脉内皮依赖性舒张功能(EDV)从(3.55±2.80)%提高至(5.62±4.18)%(P=0.001),肱动脉非内皮依赖性舒张功能(GTN)从(12.62±7.48)%提高至(12.80±7.04)%(P=0.835);ARB组患者治疗后EDV从(4.42±2.95)%提高到(6.28±3.26)%(P=0.039),GTN从(10.69±5.85)μg/L下降到(9.54±4.78)%(P=0.229)。而对照组患者治疗前后EDV、GTN改变统计学差异不显著(P>0.05)。治疗前后EDV、GTN变化值比较,ACEI组和ARB组相比差异无统计学意义(P>0.05)。雷米普利5mg和伊贝沙坦150mg治疗2型糖尿病合并AS患者3个月改善血管内皮功能差异无显著性。

Abstract: Objective To compare the changes of endothelial function in type 2 diabetic patients with atherosclerosis (AS) after treatment with angiotensin-coverting enzyme inhibitor (ACEI) and angiotensinⅡreceptor blocker (ARB). Methods Totally 145 type 2 diabetic patients with AS were included in this study. According to completely randomized open unbalanced design, the patients were assigned into ACEI group (n=99) with ramipril treatment (starting dose of 2.5 mg/d and gradually reaching 5 mg/d), ARB group (n=25) with irbesartan treatment (with gradual increase of doses till reaching the maximum daily dose of 150 mg), and control group (n=21) without the above medication. After a treatment lasting for 3 months, the brachial artery endothelial function was evaluated with two-dimensional ultrasonography. Results and Conclusions After therapy, endothelium-dependent vasodilation (EDV) of the brachial artery increased from (3.55±2.80)% to (5.62±4.18)% (P=0.001), and endothelium-independent vasodilation (EIV) increased from (12.62±7.48)% to (12.80±7.04)% (P=0.835) in ACEI group. EDV increased from (4.42±2.95) % to (6.28±3.26)% (P=0.039), while EIV decreased from (10.69±5.85)% to (9.54±4.78)% (P=0.229) in ARB group. No statistical changes in the indices were found after therapy in the control group (P>0.05). Comparison of endothelial function in the 3 groups showed no statistical significance in the changes of EDV between ACEI and ARB groups (P=0.853). No differences were found in the change of EIV in the 3 groups (P=0.644). The therapy with 150 mg irbesartan and 5 mg ramipril for 3 months produces similar effects on the endothelial function in these patients.

中图分类号:

王玲, 黄新胜, 周颖玲, 陈纪言, 林曙光. 血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂改善2型糖尿病合并动脉粥样硬化患者血管内皮功能近期疗效的对比研究[J]. 南方医科大学学报, 2005, 25(08): 967-971.

WANG Ling, HUANG Xin-sheng, ZHOU Ying-ling, CHEN Ji-yan, LIN Shu-guang. Effects of angiotensin receptor blocker and angiotensin-coverting enzyme inhibitor on vascular endothelial function in type 2 diabetic patients with atherosclerosis: a comparative study[J]. Journal of Southern Medical University, 2005, 25(08): 967-971.

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