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目的:观察罗格列酮(rosiglitazone)对老年高血压并胰岛素抵抗患者心率变异性(HRV)的影响。方法:采用随机双盲、安慰剂对照研究方法,将62例老年原发性高血压并胰岛素抵抗患者随机分为罗格列酮组和安慰剂组,各口服罗格列酮4mg或安慰剂,每日1次,共16周,服药前后分别测定24h动态心电图、体质指数(BMI)、空腹胰岛素、空腹血糖、凝血因子Ⅰ和C反应蛋白。结果:罗格列酮组HRV时域及频域各项指标均有所提高(均P<0.01);胰岛素敏感性均显著提高(均P<0.01);空腹胰岛素、C反应蛋白和凝血因子Ⅰ明显降低(均P<0.01);24h平均收缩压和舒张压均降低(均P<0.05);空腹血糖和BMI差异无统计学意义(均P>0.05)。多元逐步回归分析结果表明空腹胰岛素是与HRV最为密切的因素(P<0.01)。结论:罗格列酮能有效改善老年原发性高血压并胰岛素抵抗症患者HRV,提高胰岛素敏感性,降低收缩压和舒张压,减少血液中心血管危险因子;空腹胰岛素是影响HRV的重要因素。
Objective: To observe the effect of rosiglitazone on heart rate variability (HRV) in elderly patients with hypertension and insulin resistance. Methods: A randomized, double-blind, placebo-controlled study was conducted in 62 elderly patients with essential hypertension and insulin resistance who were randomized to rosiglitazone and placebo. Each received either rosiglitazone 4 mg or placebo, Once a day for 16 weeks. The dynamic electrocardiogram, body mass index (BMI), fasting insulin, fasting blood glucose, coagulation factor Ⅰ and C-reactive protein were measured 24h before and after taking the medicine. Results: The indexes of HRV in both time and frequency domain of rosiglitazone group were significantly increased (all P <0.01), insulin sensitivity was significantly increased (all P <0.01), fasting insulin, C - reactive protein and coagulation factor Ⅰ (All P <0.01). Mean systolic blood pressure and diastolic blood pressure decreased at 24h (all P <0.05). There was no significant difference between fasting blood glucose and BMI (all P> 0.05). Multiple stepwise regression analysis showed that fasting insulin was the most closely related factor with HRV (P <0.01). CONCLUSION: Rosiglitazone can effectively improve HRV in elderly patients with essential hypertension and insulin resistance, improve insulin sensitivity, reduce systolic and diastolic blood pressure, and decrease cardiovascular risk factors in blood. Fasting insulin is an important factor affecting HRV.