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目的观察血管紧张素Ⅱ受体拮抗剂氯沙坦和钙离子通道拮抗剂氨氯地平对肥胖高血压患者血浆瘦素、脂联素、去甲肾上腺素(NE)水平和胰岛素敏感性的影响。方法采用放射免疫法测定血浆瘦素及脂联素水平、采用稳态模型评价胰岛素抵抗指数(HOMA-IR),以高效液相色谱检测血浆NE水平。结果氯沙坦组血浆瘦素、脂联素、HOMA-IR、体重指数(BMI)治疗16周前后差异有统计学意义[分别为(35.6±18.5 vs 32.0±17.1)μg/L,P<0.05;(9.34±3.12 vs 12.45±4.52)mg/L,P<0.01;8.6±2.7 vs 6.1±2.1,P<0.05;(28.9±3.8 vs 27.3±3.2)kg/m~2,P<0.05],氨氯地平组在治疗前后差异均无统计学意义[分别为(35.2±18.3 vs 35.4±18.9)μg/L;(9.32±3.23 vs 9.39±3.41)mg/L;8.3±2.5 vs 8.7±2.9;(28.8±3.8 vs 28.7±3.6)kg/m~2];血浆NE水平在氨氯地平组治疗后明显增加[(324±112 vs 449±122)ng/L,P<0.01],氯沙坦组治疗前后差异无统计学意义[(322±115 vs 325±121)ng/L],两治疗组之间的疗效差异有统计学意义(P<0.01)。结论虽然氯沙坦和氨氯地平有等同的降压效应,但氯沙坦尚能改善与肥胖相关的代谢紊乱,因此肥胖高血压患者用氯沙坦比氨氯地平治疗可能会获得更多益处。
Objective To investigate the effects of losartan, an antagonist of angiotensin Ⅱ receptor, and amlodipine, a calcium channel blocker, on plasma leptin, adiponectin, norepinephrine (NE) and insulin sensitivity in obese hypertensive patients. Methods The levels of plasma leptin and adiponectin were measured by radioimmunoassay. The homeostasis model was used to evaluate the insulin resistance index (HOMA-IR) and plasma levels of NE were detected by HPLC. Results The levels of plasma leptin, adiponectin, HOMA-IR and body mass index (BMI) in losartan group were statistically significant at 16 weeks after treatment (35.6 ± 18.5 vs 32.0 ± 17.1 μg / L, P <0.05 ; P <0.05); (9.34 ± 3.12 vs 12.45 ± 4.52) mg / L, P <0.01; 8.6 ± 2.7 vs 6.1 ± 2.1, P <0.05; There was no significant difference between the amlodipine group before and after treatment [(35.2 ± 18.3 vs 35.4 ± 18.9) μg / L, (9.32 ± 3.23 vs 9.39 ± 3.41) mg / L, 8.3 ± 2.5 vs 8.7 ± 2.9, (28.8 ± 3.8 vs 28.7 ± 3.6) kg / m ~ 2]. Plasma NE levels increased significantly after amlodipine treatment [(324 ± 112 vs 449 ± 122) ng / L, P <0.01] There was no significant difference between the two groups before and after treatment [(322 ± 115 vs 325 ± 121) ng / L]. The difference between the two groups was statistically significant (P <0.01). Conclusions Although losartan and amlodipine have equivalent antihypertensive effects, losartan can still improve obesity-related metabolic disorders and therefore may benefit more from losartan than amlodipine in obese hypertensive patients .