【摘要】 目的比较血管紧张素转换酶抑制剂(ACEI)依那普利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患者用完全随机设计,将患者分为ACEI组47例,依那普利开始剂量2.5mg/d,逐渐加至5mg/d;ARB组49例,用伊贝沙坦逐渐加量至150mg/d;对照组48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ACEI组患者治疗后肱动脉内皮依赖性舒张功能(EDV)从(3.3±2.7)%提高至(5.6±4.2)%(P=0.001),肱动脉非内皮依赖性舒张功能(EIV)从(12.6±7.4)%提高至(12.8±7.1)%(P=0.835);ARB组患者治疗后EDV从(4.4±2.9)%提高到(6.2±3.2)%(P=0.038),EIV从(10.6±5.8)%下降到(9.5±4.7)%(P=0.230);而对照组患者治疗前、后EDV、EIV改变差异无统计学意义(P>0.05)。治疗前、后EDV、EIV变化值比较,ACEI组和ARB组相比差异无统计学意义(P>0.05)。结论依那普利和伊贝沙坦均可改善2型糖尿病合并动脉粥样硬化患者的肱动脉内皮功能。更多还原

【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 144 type 2 diabetic patients with AS were included in this study. The patients were assigned into ACEI group (n=47) with enalapril treatment(starting dose of 2.5 mg/d and graduallyreaching 5 mg/d),ARB group (n=49) with irbesartan treatment(with gradual increase of doses till reaching the maximumdaily dose of 150 mg),and control group(n=48) without the above medication. After a treatment lasting for 3 months, the brachial artery endothelial function was evaluated with two-dimensiona lultrasonography. Results After therapy,endothelium-dependent vasodilation(EDV)of the brachial artery increased from (3.3±2.7)% to(5.6±4.2)% (P=0.001),and endothelium-independent vasodilation(EIV)increased from(12.6±7.4)% to (12.8±7.1)%(P=0.835) in ACEI group. EDV increased from (4.4±2.9)% to (6.2±3.2)% (P=0.038),while EIV decreased from (10.6±5.8)% to (9.5±4.7)% (P=0.230) 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).Conclusion The therapy with 150 mg irbesartan and 5 mg enalapril for 3 months produces similar effects on the endothelial function in these patients.更多还原