慢性利尿剂治疗对葡萄糖稳态的影响。
Impact of chronic diuretic treatment on glucose homeostasis.
机构信息
Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS) - Laboratorio di Nutrizione Clinica, University of Palermo, Via del Vespro, 129, Palermo 90127, Italy.
出版信息
Diabetol Metab Syndr. 2013 Dec 13;5(1):80. doi: 10.1186/1758-5996-5-80.
BACKGROUND
The use of diuretics for hypertension has been associated with unfavorable changes in cardiovascular risk factors, such as uric acid and glucose tolerance, though the findings in the literature are contradictory.
METHODS
This study investigated whether diuretic use is associated with markers of metabolic and cardiovascular risk, such as insulin-resistance and uric acid, in a cohort of adults without known diabetes and/or atherosclerotic cardiovascular disease. Nine hundred sixty-nine randomly selected participants answered a questionnaire on clinical history and dietary habits. Laboratory blood measurements were obtained in 507 participants.
RESULTS
Previously undiagnosed type 2 diabetes was recognized in 4.2% of participants who were on diuretics (n = 71), and in 2% of those who were not (n = 890; P = 0.53). Pre-diabetes was diagnosed in 38% of patients who were on diuretics, and in 17.4% (P < 0.001) of those who were not. Multivariate analysis showed that insulin-resistance (HOMA-IR) was associated with the use of diuretics (P = 0.002) independent of other well-known predisposing factors, such as diet, physical activity, body mass index, and waist circumference. The use of diuretics was also independently associated with fasting plasma glucose concentrations (P = 0.001) and uric acid concentrations (P = 0.01).
CONCLUSIONS
The use of diuretics is associated with insulin-resistance and serum uric acid levels and may contribute to abnormal glucose tolerance.
背景
利尿剂在高血压治疗中的应用与心血管风险因素的不利变化有关，如尿酸和葡萄糖耐量，但文献中的研究结果存在矛盾。
方法
本研究调查了在一组无已知糖尿病和/或动脉粥样硬化性心血管疾病的成年人中，利尿剂的使用是否与代谢和心血管风险标志物（如胰岛素抵抗和尿酸）相关。969 名随机选择的参与者回答了一份关于临床病史和饮食习惯的问卷。507 名参与者进行了实验室血液测量。
结果
在服用利尿剂的参与者中（n=71），有 4.2%被诊断为未经诊断的 2 型糖尿病，而在未服用利尿剂的参与者中（n=890），这一比例为 2%（P=0.53）。在服用利尿剂的患者中，有 38%被诊断为糖尿病前期，而在未服用利尿剂的患者中，这一比例为 17.4%（P<0.001）。多变量分析表明，胰岛素抵抗（HOMA-IR）与利尿剂的使用相关（P=0.002），与其他已知的易患因素（如饮食、体育活动、体重指数和腰围）无关。利尿剂的使用也与空腹血糖浓度（P=0.001）和尿酸浓度（P=0.01）独立相关。
结论
利尿剂的使用与胰岛素抵抗和血清尿酸水平相关，并可能导致葡萄糖耐量异常。
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