CAJ | 학술논문

目的研究国产血管紧张素Ⅱ受体拮抗剂（ ARB）类药物穗悦对2型糖尿病合并高血压患者的治疗效果。方法选取符合WHO的1999年2型糖尿病诊断标准，尿常规蛋白阴性的患者166例，年龄35～70岁，男90例，女76例，其中合并高血压者137例，按是否使用穗悦治疗分为穗悦组与非穗悦组，血压正常者29例，为对照组。所有患者每月测定血压，测定基线及治疗1年、2年时肝肾功能、血糖、糖化血红蛋白、8 h尿蛋白排泄率（UAER）、颈动脉内膜中层厚度（IMT）。结果（1）基线时穗悦组与非穗悦组及对照组比较，年龄、糖尿病病程、体质指数、肝肾功能、血糖、8 h UAER无显著差异（ P＞0.05）。（2）基线时穗悦组高血压病程较长，收缩压及舒张压较非穗悦组显著增高（ P＜0.05）；治疗1年及2年时，穗悦组收缩压与舒张压较治疗前均有显著下降（P＜0.05），收缩压仍稍高于非穗悦组与对照组，舒张压与非穗悦组及对照组无显著差异（P＞0.05）；非穗悦组仅2年时舒张压有显著下降（P＜0.05）。（3）基线时颈动脉IMT在穗悦组与非穗悦组间无明显差异，较对照组稍增厚；治疗1年及2年时，穗悦组与非穗悦组比较颈动脉IMT无显著差异（P＞0.05），较对照组仍稍增厚（P＜0.05）。（4）基线时8 h UAER穗悦组与非穗悦组比较，穗悦组与对照组比较均无显著差异（ P＞0.05）；治疗2年时穗悦组8 h UAER有显著下降（ P＜0.05）。结论穗悦在2型糖尿病合并高血压，尿常规蛋白阴性的患者中，能有效降低血压，尤其是舒张压，减少尿微量白蛋白排泄率，可能对动脉硬化有一定保护作用。
목적연구국산혈관긴장소Ⅱ수체길항제（ ARB）류약물수열대2형당뇨병합병고혈압환자적치료효과。방법선취부합WHO적1999년2형당뇨병진단표준，뇨상규단백음성적환자166례，년령35～70세，남90례，녀76례，기중합병고혈압자137례，안시부사용수열치료분위수열조여비수열조，혈압정상자29례，위대조조。소유환자매월측정혈압，측정기선급치료1년、2년시간신공능、혈당、당화혈홍단백、8 h뇨단백배설솔（UAER）、경동맥내막중층후도（IMT）。결과（1）기선시수열조여비수열조급대조조비교，년령、당뇨병병정、체질지수、간신공능、혈당、8 h UAER무현저차이（ P＞0.05）。（2）기선시수열조고혈압병정교장，수축압급서장압교비수열조현저증고（ P＜0.05）；치료1년급2년시，수열조수축압여서장압교치료전균유현저하강（P＜0.05），수축압잉초고우비수열조여대조조，서장압여비수열조급대조조무현저차이（P＞0.05）；비수열조부2년시서장압유현저하강（P＜0.05）。（3）기선시경동맥IMT재수열조여비수열조간무명현차이，교대조조초증후；치료1년급2년시，수열조여비수열조비교경동맥IMT무현저차이（P＞0.05），교대조조잉초증후（P＜0.05）。（4）기선시8 h UAER수열조여비수열조비교，수열조여대조조비교균무현저차이（ P＞0.05）；치료2년시수열조8 h UAER유현저하강（ P＜0.05）。결론수열재2형당뇨병합병고혈압，뇨상규단백음성적환자중，능유효강저혈압，우기시서장압，감소뇨미량백단백배설솔，가능대동맥경화유일정보호작용。
Objective To evaluate the efficacy of valsartan on the treatment of hypertension in type 2 diabetes patients .Methods A total of 166 type 2 diabetes patients aged 35 to 70 years without proteinuria were eligible.137 patients with hypertension were assigned to receive valsartan (VAL group,n=83)80 mg once daily or other antihypertensive drugs(OAD group,n=54)for 2 years.29 type 2 diabetes patients without hypertension were in control group.Assessments were made at baseline and after 1 and 2 years of treatment.Results (1)There were no significant differences in age ,body mass index ,course of type 2 diabetes or microalbuminuria among the three groups (P>0.05).(2)The course of hypertension in VAL group was longer than OAD group ,and the systolic pressure and diastolic pressure in VAL group were higher than in OAD group at baseline .After 1 and 2 years treatment , the diastolic and systolic blood pressure significantly decreased in VAL group (P<0.05),but the systolic blood pressure was still higher than the other groups .The diastolic blood pressure had no difference among the three groups ( P>0.05),but it decreased in OAD group at the end comparing to baseline (P<0.05).(3)There were no significant differences in carotid intima-media thickness between VAL group and OAD group at baseline .Carotid intima-media thickness in VAL group was thicker than control group at the baseline .At the end of 2 years′therapy,there were no statistically significant differences in carotid intima-media thickness between VAL group and OAD group ( P>0.05 ) . Carotid intima-media thickness in VAL group was thicker than control group ( P <0.05 ) .( 4 ) There were no significant differences in UAER among the three groups ( P>0.05 ) at the baseline .UAER was reduced significantly (P<0.05)in VAL group 2 years later.Conclusion Valsartan is a safe and effective therapy for lowering BP in type 2 diabetes patients without proteinuria ,especially of the systolic blood pressure .Valsartan may reduce the albuminuria and retard atherosclerosis .