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[高血压、糖尿病、动脉粥样硬化:代谢综合征X的临床表现。药物治疗前景]

[Hypertension, diabetes mellitus, atherosclerosis: clinical manifestations of metabolic syndrome X. Prospects of pharmacological treatment].

作者信息

Moiseev V S, Ivleva A Ia, Kobalava Zh D

出版信息

Vestn Ross Akad Med Nauk. 1995(5):15-8.

PMID:7626978
Abstract

Currently available data and clinical observations which suggest that there is a pathogenetic relationship between hypertension, diabetes mellitus, and atherosclerosis have provided a concept of the X syndrome, by which hypertensive patients, mainly males, have impaired insulin tolerance along with hyperinsulinemia and concurrent atherogenic disorders of lipid metabolism. The paper discussed the specific pathogenetic mechanisms, clinical manifestations, and prospects for drug correction of the metabolic syndrome. The treatment of arterial hypertension with the calcium antagonist Lomir has indicated there are no negative changes as a control of non-insulin-dependent diabetes mellitus in the presence of effective correction of arterial hypertension and atherogenic dyslipidemias. With the monotherapy of essential hypertension concurrent with hypercholesterolemia with the alpha 1-adrenoblocker Doxazosin, in addition to the agent's high antihypertensive effects, the authors noted its favourable action on lipid spectral parameters and platelet functional activity. There is abundant evidence for the use of specific hypolipidemic agents in patients with essential hypertensive refractory to current antihypertensive drugs. The data obtained with the use of Lescol (fluvastatin) in patients with hypertensive disease and hypercholesterolemia suggest that by substantially reducing the levels of total cholesterol, triglycerides, low density lipoprotein cholesterol and its transport protein apo B does not deteriorate the quality of correction of arterial hypertension in this group of patients.

摘要

目前可得的数据和临床观察表明,高血压、糖尿病和动脉粥样硬化之间存在发病机制上的关联,由此提出了X综合征的概念,即高血压患者(主要为男性)存在胰岛素耐受性受损、高胰岛素血症以及并发脂质代谢的致动脉粥样硬化紊乱。本文讨论了代谢综合征的具体发病机制、临床表现以及药物纠正的前景。使用钙拮抗剂洛美利治疗动脉高血压表明,在有效纠正动脉高血压和致动脉粥样硬化血脂异常的情况下,对非胰岛素依赖型糖尿病的控制没有负面影响。对于原发性高血压合并高胆固醇血症患者,使用α1肾上腺素能阻滞剂多沙唑嗪进行单一疗法,除了该药物具有较高的降压效果外,作者还指出其对血脂谱参数和血小板功能活性具有有利作用。有充分证据表明,对于目前使用的抗高血压药物治疗无效的原发性高血压患者,可使用特定的降血脂药物。在高血压病合并高胆固醇血症患者中使用来适可(氟伐他汀)所获得的数据表明,通过大幅降低总胆固醇、甘油三酯、低密度脂蛋白胆固醇及其转运蛋白载脂蛋白B的水平,并不会恶化该组患者动脉高血压的纠正质量。

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