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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。
Objective To evaluate the effect of pioglitazone on fibrinolytic function in elderly patients with hypertension and insulin resistance. Methods Twenty-four elderly patients with hypertension and insulin resistance were treated with pioglitazone 15 mg daily for 16 weeks. Before and after treatment, the levels of plasminogen activator inhibitor-1 (PAI-1), tissue-type plasminogen activator, Dimer and fibrinogen content, fasting insulin, fasting blood glucose and ambulatory blood pressure 24 h. Results After treatment with pioglitazone, plasma plasminogen activator inhibitor-1 and dimer antigen levels were significantly decreased (P <0.01), tissue plasminogen activator antigen level was significantly increased (P <0.01), insulin sensitivity index (P <0.01), fasting insulin and fibrinogen were significantly decreased (P <0.01), mean systolic and diastolic blood pressure were lower at 24 h (P <0.05). Multivariate analysis showed that pre-treatment fasting insulin levels had the greatest effect on PAI-1 reduction (P <0.01). Conclusion Pioglitazone can effectively improve the function of fibrinolytic system in elderly patients with hypertension and insulin resistance, improve insulin sensitivity and reduce systolic and diastolic blood pressure; fasting insulin level is the main factor affecting the fibrinolytic function of patients.