胰岛素抵抗与高血压的研究进展
出处:论文网
时间:2007-09-15
3.2.3 a-糖苷酶抑制剂
其代表药物阿卡波糖,近年来的研究显示,该类药物可改善外周靶组织对胰岛素的敏感性,可阻止蔗糖诱导高血压鼠的血浆葡萄糖及胰岛素水平的升高,并可能通过尿Na+增加间接地使血压保持正常[25]。
某些中药也可以改善胰岛素敏感性,尤其是黄连的主要成分盐酸小檗碱,中药金芪降糖片(含黄连)在降低血糖、改善胰岛素抵抗的同时可以明显降低果糖诱导的胰岛素抵抗高血压大鼠的血压[26]。
应该注意的是高血压和代谢综合征不仅在药物治疗方面有交叉,非药物治疗方面也比较一致,高血压防治指南和对代谢综合征建议中均强调了这一点,尤其是减轻体重和适当的体力活动。
胰岛素抵抗和高血压的发生均为多因素,进一步的临床研究应区分各种情况,如高胰岛素血症和低胰岛素血症。而在临床实践中对于代谢综合征高血压患者建议联合应用增加胰岛素敏感性的药物,部分病例甚至可以考虑单用。进一步的研究可能为高血压病及其他心脑血管病的全面治疗带来新的变化。
[参考文献]
1 Reaven GM.Role of insulin resistance in human disease.Diabetes,1988,37:1595-1607.
2 World Health Organization.Definition,diagnosis and classification of diabetes mellitus and its complications.Report of a WHO consultation, Part 1: Diagnosis and classification of diabetes mellitus.Geneva,WHO,1999.
3 中华医学会糖尿病学分会代谢综合征研究协作组.中华医学会糖尿病学分会关于代谢综合征的建议.中华糖尿病杂志,2004,12:156-161.
4 Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults.Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel Ⅲ).JAMA,2001,285:2486-2497.
5 Wahrenberg H,Hertel K,Leijonhufvud BM.Use of waist circumference to predict insulin resistance:retrospective study.BMJ,2005,330:1363-1364.
6 Guo X,Cheng S,Taylor KD,et al.Hypertension genes are genetic markers for insulin sensitivity and resistance.Hypertension,2005,45:799-803.
7 Welborn TA,Breckenridge A,Rubinstein AH,et al.Seruminsulin in essential hypertension and in peripheral vascular disease.Lancet,1966,1:1336-1337.
8 Shamiss A,Carroll J,Rosenthal T.Insulin resistance in secondary hypertension.Am J Hypertens,1992,5:26-28.
9 Nagai M,Kamide K,Rakugi H,et al.Role of endothelin-1 induced by insulin in the regulation of vascular cell growth.Am J Hypertens,2003,16:223-228.
10 Kuboki K,Jiang ZY,Takahara N,et al.Regulation of endothelial constitutive nitric oxide synthase gene expression in endothelial cells and in vivo: a specific vascular action of insulin.Circulation,2000,101:676-681.
11 臧贵明,杨晔,石湘芸,等.高血压病患者血浆胰岛素原和真胰岛素水平及雷米普利干预的影响.中华内科杂志,2002,41:117-119.
12 Gueyffier F,Boissel JP,Plouin PF.CAPPP trial captopril prevention project.Lancet,1999,353:1795-1796.
13 Yusuf S,Sleight P,Pogue J,et al.Effects of an angiotensinconvertingenzyme inhibitor,ramipril,on cardiovascular events in highrisk patients.The heart outcomes prevention evaluation study investigators.N Engl J Med,2000,342:145-153.
14 Allhat officers and coordinators for the allhat collaborative research group.The antihypertensive and lipidlowering treatment to prevent heart attack trial.Major outcomes in moderately hypercholesterolemic,hypertensive patients randomized to pravastatin vs usual care:The antihypertensive and lipidlowering treatment to prevent heart attack trial (ALLHATLLT).JAMA,2002,288:2998-3007.
15 Dahlof B,Devereux RB,Kjeldsen SE,et al.LIFE Study Group.Cardiovascular morbidity and mortality in the losartan intervention for endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol.Lancet,2002,359:995-1003.
16 Kjeldsen SE,Julius S,Brunner H,et al.Characteristics of 15,314 hypertensive patients at high coronary risk.The Value trial.The valsartan antihypertensive longterm use Evaluation.Blood Press,2001,10:83-91.
17 Rocchini AP,Yang JQ,Gokee A.Hypertension and insulin resistance are not directly related in obese dogs.Hypertension,2004,43:1011-1016.
18 Suzuki M,Kanazawa A,Hasegawa M,et al.Improvement of insulin resistance in essential hypertension by longacting Ca antagonist benidipine.Clin Exp Hypertens,1999,21:1327.
19 王浩,杨晔,丁青艾,等.罗格列酮对胰岛素抵抗大鼠血清基质金属蛋白酶9和血压的影响.中国动脉硬化杂志,2004,12:690.
20 Tsai YS,Kim HJ,Takahashi N,et al.Hypertension and abnormal fat distribution but not insulin resistance in mice with P465L PPARgamma.J Clin Invest,2004,114:240-249.
21 Raji A,Seely EW,Bekins SA,et al.Rosiglitazone improves insulin sensitivity and lowers blood pressure in hypertensive patients.Diabetes Care,2003,26:172-178.
22 Schafers RF.Do effects on blood pressure contribute to improved clinical outcomes with metformin? Diabetes Metab,2003,29:6S62-6S70.
23 Manzella D,Grella R,Esposito K,et al.Blood pressure and cardiac autonomic nervous system in obese type 2 diabetic patients:effect of metformin administration.Am J Hypertens,2004,17:223-227.
24 王志国,杨晔,高连如,等.行为干预加二甲双胍对代谢综合征生物学和血生化指标的影响.中国临床康复,2004,8:3528-3529.
25 Madar E,Melamed EC,Zimlichman R,et al.Acarbose reduces blood pressure in sucroseinduced hypertension in rats.Isr J Med Sci,1997,33:153-159.
26 杨晔,王志国,王浩,等.金芪降糖片对胰岛素抵抗和高血压的影响.天津医药,2005,33:298-300.