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目的探讨在无代谢紊乱的轻、中度高血压患者中,吲哒帕胺对糖、脂代谢及尿微量白蛋白的影响。方法无糖、脂代谢紊乱的轻、中度原发性高血压患者,2 wk洗脱期后,随机分成2组:吲哒帕胺组(2.5 mg.d-1)和尼群地平组(30 mg.d-1),连续给药4 wk。治疗前及治疗6、12 mo后检测空腹血糖、服糖后2 h血糖、胰岛素、血脂、肾功能、血电解质和尿微量白蛋白与尿肌酐比值,观察2组临床生化代谢指标和胰岛素抵抗程度的差异。结果完成随访465例,男性277例,女性188例,其中吲哒帕胺组246例,尼群地平组219例。随访(11.1±s 2.8)mo,年龄(54±10)岁。吲哒帕胺组治疗6、12 mo后,仅血压、血钾、血尿酸与治疗前相比有显著差异(P<0.05),其余各项生化指标无显著差异(P>0.05)。吲哒帕胺组治疗12 mo后共38例患者发生低血钾,占15.4%(38/246)。低钾时空腹血糖明显升高,胰岛素抵抗指数明显升高(P<0.05,P<0.01)。吲哒帕胺组新发糖尿病9例,尼群地平组新发糖尿病8例,2组间新发糖尿病无显著差异(P=0.799)。结论吲哒帕胺在轻、中度无代谢紊乱的高血压患者中对糖、脂代谢无不良影响,但是长期服用后,尤其是2.5 mg.d-1,会导致低血钾和高尿酸血症,因此需定期监测血钾和血尿酸。
Objective To investigate the effects of indapamide on glucose, lipid metabolism and urine microalbumin in mild and moderate hypertensive patients without metabolic disorders. Methods Patients with mild to moderate essential hypertension without glucose and lipid metabolism were randomly divided into 2 groups: indapamide group (2.5 mg.d-1) and nitrendipine group (n = 30 mg.d-1) for 4 wk. Blood glucose, insulin, blood fat, renal function, blood electrolytes and urine microalbumin and urine creatinine were measured before treatment and 6 and 12 months after treatment. The clinical biochemical metabolic indexes and the degree of insulin resistance The difference. Results A total of 465 patients were followed up, including 277 males and 188 females, of whom 246 were indapamide and 219 were treated with nitrendipine. Follow-up (11.1 ± s 2.8) mo, age (54 ± 10) years old. After 6 and 12 months of treatment with indapamide alone, only blood pressure, serum potassium and serum uric acid were significantly different from those before treatment (P <0.05). There was no significant difference in other biochemical indexes between indapamide group and control group (P> 0.05). In the indapamide group, a total of 38 patients developed hypokalemia at 12 months, accounting for 15.4% (38/246). Hypokalemia fasting plasma glucose was significantly increased, insulin resistance index was significantly increased (P <0.05, P <0.01). There were 9 cases of new-onset diabetes in indapamide group and 8 cases of new-onset diabetes in nitrendipine group. There was no significant difference in new-onset diabetes between the two groups (P = 0.799). Conclusion Indapamide has no adverse effect on glucose and lipid metabolism in hypertensive patients with mild to moderate metabolic disturbance, but after long-term use, especially 2.5 mg.d-1, it can cause hypokalemia and hyperuricemia Therefore, it is necessary to regularly monitor serum potassium and serum uric acid.