【摘要】 目的评价吡格列酮对老年高血压并胰岛素抵抗病人纤溶功能的影响。方法24例老年高血压并胰岛素抵抗病人口服吡格列酮15mg/d,共16周,服药前后分别测定血浆纤溶酶原激活物抑制物-1(PAI-1)、组织型纤溶酶原激活物、二聚体和纤维蛋白原含量,同时测定空腹胰岛素、空腹血糖和24 h动态血压。结果吡格列酮治疗后血浆纤溶酶原激活物抑制物-1、二聚体抗原水平明显下降(P<0.01),组织型纤溶酶原激活物抗原水平明显增加(P<0.01),胰岛素敏感指数显著提高(P<0.01),空腹胰岛素和纤维蛋白原明显降低(P<0.01);24 h平均收缩压和舒张压均降低(P<0.05)。多因素分析结果表明治疗前空腹胰岛素水平对PAI-1的降低影响最大(P<0.01)。结论吡格列酮能有效改善老年高血压并胰岛素抵抗病人纤溶系统功能,提高胰岛素敏感性,降低收缩压和舒张压;空腹胰岛素水平是影响病人纤溶功能的主要因素。更多还原

【Abstract】 Objective To examine the effects of pioglitazone on fibrinolytic system in elderly hypertensive patients with insulin resistance.Methods A total of 24 elderly hypertensive patients with insulin resistance were studied before and after pioglitazone treatment.Subjects took pioglitazone(15mg/d)and usual antihypertensive medicines for 16 weeks.Before and after pioglitazone treatment,plasminogen activator inhibitor-1(PAI-1),tissue-type plasminogen activator(t-PA)and D-dimer(D-D)were determined by enzyme-linked immunosorbent assay(ELISA),24h ambulatory blood pressure,fibrinogen,fasting plasma glucose and fasting plasma insulin were also tested.Results After treatment with pioglitazone,PAI-1 and D-D antigen levels were declined significantly(P<0.01).t-PA antigen level was increased significantly(P<0.01),insulin sensitivity index(ISI)was improved significantly(P<0.01).There were significant decreases in 24h mean systolic and diastolic blood pressure(P<0.05),respectively.Fibrinogen was also declined(P<0.01),multiple factors analysis demonstrated that fasting plasma insulin(P<0.01) was a parameter that had close relationship with PAI-1.Conclusion Pioglitazone treatment for elderly hypertensive patients with insulin resistance improves fibrinolytic function and insulin sensitivity.Fasting plasma insulin is associated with PAI-1.Insulin sensitivers provide cardiovascular benefits when used in the treatment of the elderly hypertensive patients with insulin resistance.更多还原