Center for Clinical Residency Program, Tottori University Hospital, Yonago, Japan.
Circ J. 2010 Nov;74(11):2346-52. doi: 10.1253/circj.cj-10-0395. Epub 2010 Sep 4.
Angiotensin II and insulin resistance (IR) have clinical implications in the pathophysiology of chronic heart failure (CHF). However, it is still unclear whether the combination of an angiotensin-receptor blocker and angiotensin-converting enzyme inhibitor (ACEI) improves IR in CHF patients who do not receive β-blockers. Thus, the aim of the present study was to evaluate the effects of losartan on glucose metabolism and inflammatory cytokines in CHF patients treated with ACEI but not β-blockers.
The effect of losartan treatment for 16 weeks on IR was analyzed in 16 CHF patients in a randomized crossover trial. Insulin level and homeostasis model IR index (HOMA-IR) decreased significantly (P<0.05), but fasting plasma glucose did not change significantly. Serum tumor necrosis factor (TNF)-α, interleukin (IL)-6, and monocyte chemoattractant protein (MCP)-1 levels were significantly decreased with losartan (P<0.05). Furthermore, the changes in IL-6 and MCP-1 levels were significantly correlated with the reduction in HOMA-IR (P<0.05), but the change in TNF-α levels was not significantly correlated.
The addition of losartan to ACEI therapy improved IR and decreased inflammatory cytokines in CHF patients who did not receive β-blockers.
血管紧张素 II 和胰岛素抵抗（IR）在慢性心力衰竭（CHF）的病理生理学中有临床意义。然而，目前尚不清楚在不接受β受体阻滞剂的 CHF 患者中，血管紧张素受体阻滞剂和血管紧张素转换酶抑制剂（ACEI）的联合使用是否会改善 IR。因此，本研究旨在评估氯沙坦对接受 ACEI 但未接受β受体阻滞剂治疗的 CHF 患者葡萄糖代谢和炎症细胞因子的影响。
在一项随机交叉试验中，分析了 16 例 CHF 患者接受氯沙坦治疗 16 周对 IR 的影响。胰岛素水平和稳态模型 IR 指数（HOMA-IR）显著降低（P<0.05），但空腹血糖无明显变化。血清肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6 和单核细胞趋化蛋白-1（MCP）-1 水平随氯沙坦显著降低（P<0.05）。此外，IL-6 和 MCP-1 水平的变化与 HOMA-IR 的降低显著相关（P<0.05），但 TNF-α水平的变化与 HOMA-IR 的降低不显著相关。
在未接受β受体阻滞剂的 CHF 患者中，ACEI 联合氯沙坦治疗可改善 IR 并降低炎症细胞因子。
