Hrnciar J, Jakubíková K, Okapcová J
Interná klinika NsP F. D. Roosevelta, B. Bystrica.
Vnitr Lek. 1992 Aug;38(8):729-37.
The authors summarize the principles of the therapeutic approach to the 5H syndrome [1. hyperinsulinism, 2. hyperglycaemia (NIDDM), 3. hyperlipoproteinaemia (obesity), 4. hypertension, 5. hirsutism], in particular its two components, i.e. NIDDM and arterial hypertension. The authors found that early treatment of hyperinsulinism, e.g. already in the stage of impaired glucose tolerance or NIDDM with oral antidiabetics, their disproportionate increase with regard to the blood sugar level and glycosylated haemoglobin without making "hygienic" provisions (radical weight reduction; increased physical activity to the maximum possible individual level; energy restricted diet in particular as regards carbohydrates and fat) does not prevent progression of the components of the 5H syndrome to the clinical stage. In treatment of arterial hypertension associated with 5H syndrome non-selective beta-blockers and thiazide diuretics are unsuitable because they worsen the HPLP and enhance insulin resistance. Suitable preparations are combinations of ACE-inhibitors, calcium antagonists, selective beta-blockers in particular with ISA and beta-blockers with a partial selective sympathomimetic activity (devalol and celiprolol). Hygienic provisions must be started in childhood, or when hyperinsulinism is detected.
作者总结了针对5H综合征[1. 高胰岛素血症，2. 高血糖症（非胰岛素依赖型糖尿病），3. 高脂蛋白血症（肥胖症），4. 高血压，5. 多毛症]的治疗方法原则，尤其是其两个组成部分，即非胰岛素依赖型糖尿病和动脉高血压。作者发现，早期治疗高胰岛素血症，例如在糖耐量受损阶段或使用口服降糖药治疗非胰岛素依赖型糖尿病时，如果不做出“卫生”方面的规定（彻底减轻体重；将体育活动增加到个人可能的最大水平；特别是在碳水化合物和脂肪方面限制能量饮食），血糖水平和糖化血红蛋白不成比例地升高并不能阻止5H综合征各组成部分发展到临床阶段。在治疗与5H综合征相关的动脉高血压时，非选择性β受体阻滞剂和噻嗪类利尿剂不合适，因为它们会使高脂蛋白血症恶化并增强胰岛素抵抗。合适的制剂是血管紧张素转换酶抑制剂、钙拮抗剂、特别是具有内在拟交感活性的选择性β受体阻滞剂以及具有部分选择性拟交感神经活性的β受体阻滞剂（地伐洛尔和塞利洛尔）的组合。必须在儿童期或检测到高胰岛素血症时就开始采取卫生方面的措施。
