本文選題：單純空腹血糖受損 + 原發(fā)性高血壓��； 參考：《第三軍醫(yī)大學(xué)》2015年碩士論文

【摘要】：背景:大量的研究顯示,空腹血糖受損(IFG)是預(yù)測(cè)糖尿病發(fā)生風(fēng)險(xiǎn)的獨(dú)立危險(xiǎn)因素,空腹血糖受損(IFG)人群進(jìn)展為糖尿病的風(fēng)險(xiǎn)明顯高于普通人群,是未來(lái)發(fā)展成糖尿病的龐大候選人群。目前,已涌現(xiàn)出大量有關(guān)空腹血糖受損的臨床與基礎(chǔ)研究,同時(shí)有流行病學(xué)研究顯示,空腹血糖受損(IFG)和糖耐量異常(impaired glucose tolerance,IGT)只有一部分重疊人群,而兩者在胰島素抵抗(insulin resistance,IR)的位點(diǎn)上存在明顯不同,因此探索單純空腹血糖受損(isolated impaired fasting glucose,i-IFG)患者的起病與轉(zhuǎn)歸有重要的臨床意義。而循證證據(jù)顯示,40%~50%的原發(fā)性高血壓患者存在著胰島素抵抗現(xiàn)象,胰島素抵抗往往又帶來(lái)血糖的異常,近年來(lái),原發(fā)性高血壓病(Essential Hypertension,EH)與糖尿病前期及2型糖尿病是否存在共同的病理生理基礎(chǔ)是國(guó)內(nèi)外研究的重點(diǎn)。雖然有部分關(guān)于原發(fā)性高血壓病的研究發(fā)現(xiàn)血管緊張素受體拮抗劑可使2型糖尿病的發(fā)生風(fēng)險(xiǎn)降低,但是在這些研究中并沒(méi)有明確說(shuō)明是不同降壓水平還是降壓藥物自身帶來(lái)的臨床獲益,而對(duì)單純空腹血糖受損(i-IFG)合并原發(fā)性高血壓(EH)患者的臨床轉(zhuǎn)歸和干預(yù)研究更少。因此探索阻止或減少單純空腹血糖受損(i-IFG)合并原發(fā)性高血壓(EH)患者向糖尿病轉(zhuǎn)變的方法,觀察高血壓這一危險(xiǎn)因素對(duì)單純空腹血糖受損(i-IFG)臨床轉(zhuǎn)歸的影響,以及觀察是降壓藥物本身使血糖獲益還是血壓水平下降帶來(lái)的異常血糖的改善,達(dá)到有效地預(yù)防或延緩2型糖尿病的發(fā)生,具有重要的研究?jī)r(jià)值和意義。目的:觀察單純空腹血糖受損患者的胰島素抵抗和胰島功能與血壓的相關(guān)性,研究血壓降低后,單純空腹血糖受損合并原發(fā)性高血壓病的患者的胰島功能和胰島素抵抗的變化。研究設(shè)計(jì)與方法:本研究分兩部分實(shí)驗(yàn)進(jìn)行:第一部分:選取既往無(wú)糖尿病病史的單純空腹血糖受損患者180例,測(cè)定血壓后分為原發(fā)性高血壓組(n=94例)、血壓正常組(n=86例),兩組均給予健康的生活方式指導(dǎo),原發(fā)性高血壓組的患者均給予臨床常用降壓治療(血管緊張素受體拮抗劑或鈣離子通道阻滯劑),對(duì)比分析治療6個(gè)月前后兩組患者的空腹血糖(fpg)、空腹胰島素(fins)、ogtt試驗(yàn)后2h血糖(2hpg)、ogtt試驗(yàn)后2h胰島素(2hins)、糖化血紅蛋白(glycosylatedhemoglobin,hba1c),并計(jì)算胰島素抵抗指數(shù)(homa-ir,thehomeostasismodelofinsulinresistance)的變化情況。第二部分:選取原發(fā)性高血壓伴單純空腹血糖異�；颊�244例,隨機(jī)(124:120)分別給予50mg/d~100mg/d的氯沙坦鉀片或2.5mg/d~5.0mg/d的苯磺酸左旋氨氯地平片強(qiáng)化降壓治療3年,并同時(shí)給予生活方式干預(yù)指導(dǎo),在血壓(bloodpressure,bp)達(dá)標(biāo)(bp130/80mmhg)的情況下,對(duì)比治療前后空腹血糖(fpg)、空腹胰島素(fins)、ogtt試驗(yàn)后2h血糖(2hpg)、ogtt試驗(yàn)后2h胰島素(2hins)、糖化血紅蛋白(hba1c)及胰島素敏感指數(shù)(insulinsensitivityindex,isi)的變化情況。結(jié)果:第一部分實(shí)驗(yàn)結(jié)果:與血壓正常組相比,基線時(shí)原發(fā)性高血壓組患者的空腹胰島素、餐后2小時(shí)胰島素及胰島素抵抗指數(shù)homa-ir升高較明顯,兩組差異具有顯著性(p0.5),門診隨訪6個(gè)月時(shí),高血壓組fins、2hins、homa-ir明顯降低(p0.05),其中有66例原發(fā)性高血壓患者的血壓下降達(dá)標(biāo)(即bp130/80mmhg),20例原發(fā)性高血壓患者的血壓下降沒(méi)有達(dá)標(biāo),原發(fā)性高血壓達(dá)標(biāo)亞組的fins、2hins、homa-ir降低均比原發(fā)性高血壓未達(dá)標(biāo)亞組明顯(p0.05);血壓正常組患者的fins、2hins及homa-ir與基線比較無(wú)明顯變化(p0.05),兩組間新發(fā)糖尿病的發(fā)生率無(wú)顯著差異。第二部分實(shí)驗(yàn)結(jié)果:2組治療后血壓均較治療前明顯下降(p0.05),治療12個(gè)月后氯沙坦鉀組fins、2hins水平下降,isi較治療前明顯改善(p0.05),與苯磺酸左旋氨氯地平組比較,差異具有統(tǒng)計(jì)學(xué)意義(p0.05),治療24個(gè)月、36個(gè)月后兩組fins、2hins均下降明顯,isi也改善明顯,與治療前的指標(biāo)對(duì)比差異具有顯著性(p0.05),組間無(wú)差別(p0.05),兩組間新發(fā)糖尿病無(wú)顯著差異。結(jié)論:第一部分:單純空腹血糖異常伴原發(fā)性高血壓患者胰島素抵抗明顯,該部分人群胰島素抵抗可能與血壓升高有關(guān),血壓控制達(dá)標(biāo)可改善單純空腹血糖異常伴原發(fā)性高血壓患者的胰島素抵抗和胰島功能。第二部分:血壓下降后,單純空腹血糖受損合并原發(fā)性高血壓病的患者的胰島功能和胰島素抵抗有顯著的改善。本研究中選用的降壓藥物中,氯沙坦鉀在隨訪12個(gè)月時(shí)改善胰島素抵抗及胰島功能可能優(yōu)于苯磺酸氨氯地平,但隨訪24個(gè)月、36個(gè)月時(shí),兩組胰島素抵抗及胰島功能均有明顯改善,與基線對(duì)比差異具有統(tǒng)計(jì)學(xué)意義,且兩組新發(fā)糖尿病的發(fā)生率無(wú)明顯差別,提示兩種降壓藥對(duì)胰島素抵抗及胰島功能的影響差別不明顯。
[Abstract]:Background: many studies showed that impaired fasting glucose (IFG) was an independent predictor of diabetes, impaired fasting glucose (IFG) in risk of progression to diabetes was significantly higher than that of the general population, is a huge crowd of candidate for future development into diabetes. At present, has emerged a large number of relevant clinical and impaired fasting glucose basic research and epidemiological studies showed that impaired fasting glucose (IFG) and impaired glucose tolerance (impaired glucose, tolerance, IGT) is only part of the overlap population, and both in insulin resistance (insulin resistance, IR) are obviously different sites, so the exploration of impaired fasting glucose (isolated impaired fasting glucose, i-IFG) has important clinical significance in patients with the onset and prognosis. The evidence showed that 40%~50% patients with essential hypertension have insulin resistance, insulin resistance Abnormal, often bring anti hyperglycemia in recent years, primary hypertension (Essential, Hypertension, EH) are the common pathophysiologic basis with pre diabetes and type 2 diabetes mellitus is the focus of research at home and abroad. Although there are some studies of primary hypertension found that angiotensin receptor antagonists can make 2 to reduce the risk of diabetes, but these studies did not specify that the clinical benefit of different antihypertensive or antihypertensive drugs itself, and impaired fasting glucose (i-IFG) combined with primary high blood pressure (EH) in patients with clinical outcome and intervention research less. So exploring to prevent or reduce fasting impaired fasting glucose (i-IFG) with essential hypertension (EH) method to change the patients of diabetes mellitus, hypertension risk factors of the impaired fasting glucose (i-IFG) affects clinical outcomes Well, observation of antihypertensive drugs itself benefit or make blood sugar level of blood pressure decreased abnormal blood glucose has improved, to effectively prevent or delay the onset of type 2 diabetes, has an important research value and significance. Objective: To observe the relationship between impaired fasting glucose in patients with insulin resistance and islet function and the blood pressure, blood pressure reduction research after the change of impaired fasting glucose and hypertension in patients with islet function and insulin resistance. The research design and methods: This study is divided into two parts: the first part: the experiment selected no previous history of diabetes impaired fasting glucose in patients with 180 cases, blood pressure was measured after divided into primary hypertension group (n=94 cases), normal blood pressure group (n=86 cases), two groups were given the guidance of a healthy lifestyle, essential hypertension group patients were given clinical treatment of antihypertensive (angiotensin Zhang Su receptor blocker or calcium channel blockers), the therapeutic effect of fasting blood glucose of two groups of patients before and after 6 months (FPG), fasting insulin (fins), OGTT 2H (2hPG) blood glucose test, OGTT test 2H insulin (2hins), glycosylated hemoglobin (glycosylatedhemoglobin, HbA1c), and insulin resistance index (HOMA-IR, thehomeostasismodelofinsulinresistance) were selected. The second part: the primary 244 patients with abnormal fasting glucose and hypertension, randomly (124:120) were treated with 50mg/d~ 100mg/d or Losartan Potassium Tablets 2.5mg/d~5.0mg/d Levamlodipine Besylate Tablets aggressiveantihypertensive treatment for 3 years, and also given lifestyle intervention, the blood pressure (bloodpressure, BP (standard) bp130/80mmhg) cases, compared the fasting blood glucose (FPG), fasting insulin (fins), OGTT 2H (2hPG) blood glucose test, OGTT test after 2 H insulin (2hins), glycosylated hemoglobin (HbA1c) and insulin sensitivity index (insulinsensitivityindex, ISI) were observed. Results: the first part: the experimental results compared with the normal blood pressure group, baseline hypertension patients with fasting insulin, 2 hour postprandial insulin and insulin resistance index HOMA-IR increased obviously in two. Group with significant difference (p0.5), outpatient follow-up at 6 months, the hypertension group fins, 2hins, HOMA-IR were significantly lower (P0.05), including 66 cases of primary hypertension patients with decreased blood pressure standard (bp130/80mmhg), 20 cases of primary hypertension patients with decreased blood pressure is not standard, essential hypertension standard sub groups of fins, 2hins, HOMA-IR were lower than the primary hypertension subgroup was not standard (P0.05); normal blood pressure group were fins, 2hins and HOMA-IR compared with baseline did not change significantly between the two groups (P0.05), new onset diabetes The disease incidence rate had no significant difference. The second part of the experiment results: the blood pressure of 2 groups were significantly decreased compared with before treatment (P0.05), after 12 months of treatment with losartan potassium group fins, 2hins decreased, ISI significantly improved than before treatment (P0.05), and levamlodipinebesylate group compared with statistically significant difference (P0.05), for 24 months, 36 months after the two groups of fins, 2hins were significantly decreased, ISI also improved significantly, with significant difference compared with the index before treatment (P0.05), no difference between the groups (P0.05), new onset diabetes between the two groups no significant difference. Conclusion: the first part: simple impaired fasting glucose with insulin resistance in patients with primary hypertension significantly, the population of insulin resistance may be associated with elevated blood pressure, blood pressure control can improve pancreatic island fasting glucose abnormality with essential hypertension in patients with insulin resistance and islet function. The second part: A drop in blood pressure, impaired fasting glucose and hypertension in patients with islet function and insulin resistance were significantly improved. In this study the selection of antihypertensive drugs, losartan at 12 months follow-up, improve insulin resistance and islet function may be better than that of benzene sulfonic acid amlodipine, but after 24 months of follow-up, 36 months, two groups of islet function and insulin resistance were significantly improved, the difference was statistically significant compared with baseline, and the two groups the incidence of new onset diabetes had no significant difference, the results suggest that the effect of two kinds of antihypertensive drugs on insulin resistance and insulin function did not differ significantly.

【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 龐進(jìn)才;彭靜;嚴(yán)麗君;;不同標(biāo)準(zhǔn)空腹血糖受損人群高血壓分布特征分析[J];中國(guó)當(dāng)代醫(yī)藥;2010年09期

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本文編號(hào)：1762662