目的 观察缬沙坦联合前列地尔治疗早期2型糖尿病(T2DM)合并高血压患者对血管内皮功能及氧化物质的影响。方法 收集2017-05至2018-09无微血管病变的早期2型糖尿病(T2DM)合并高血压患者100例,按照随机分组原则分为对照组(50 例)与观察组(50 例)。两组患者均给予降压(缬沙坦)+降糖(二甲双胍+阿卡波糖片)+改善循环(银杏叶提取物)等治疗并给予心理护理干预,观察组在此基础上给予前列地尔治疗。连续治疗60 d后测定两组患者的空腹血糖(FBG)、餐后 2 h血糖(2hPBG)、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、血管舒缩张因子[一氧化氮(NO)、内皮素-1(ET-1)、血管内皮生长因子(VEGF)]浓度及其血流介导的肱动脉内皮依赖性血管舒张功能(FMD)、硝酸甘油所介导的非内皮依赖性血管舒张功能(NMD)]、氧化相关物质[超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、活性氧类物质(ROS)活性、丙二醛(MDA)浓度]的影响,并评估临床疗效,记录治疗过程中的不良反应。结果 两组各有43例完成试验。治疗后两组FBG、PBG均低于治疗前,差异有统计学意义(P＜0.05),但治疗后两组的BMI与治疗前比较差异无统计学意义(P＞0.05),治疗后两组FBG、PBG、BMI比较差异无统计学意义(P＞0.05);治疗后两组患者的SBP、DBP、ET-1、VEGF、ROS、MDA均低于治疗前,且观察组低于对照组,差异均有统计学意义(P＜0.05)。治疗后两组患者的NO、FMD、NMD、SOD、GSH-Px均高于治疗前,且观察组高于对照组,差异均有统计学意义(P＜0.05)。治疗过程中两组均未发生严重不良反应(AEs),仅出现轻度胃肠道反应、皮疹、干咳等,且两组发生率无统计学差异(P＞0.05)。结论 在早期未发生微血管病变的T2DM合并高血压患者在降糖、降压的治疗基础上加用前列地尔能很好地改善血管内皮功能,改善氧化与抗氧化失衡状态,提高临床疗效,安全可靠。

Objective To observe the protective effect of valsartan combined with alprostadil on the function of vascular endothelium and the effect on the concentration of oxidants in patients with early type 2 diabetes mellitus (T2DM) complicated with hypertension.Methods Between May 2017 and September 2018, 100 patients with early type 2 diabetes mellitus (T2DM) complicated with hypertension but without microangiopathy were selected and randomly divided into the control group (n=50) and observation group (n=50). Both groups were treated with hypotensive drugs (valsartan), hypoglycemic drugs (metformin+acarbose tablets) and improved circulation (ginkgo biloba extract), but the observation group was additionally given alprostadil. After 60 days of continuous treatment, the levels of fasting blood glucose (FBG) and postprandial 2-hour blood glucose (2 h PBG), body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), the concentration of vasodilators [nitric oxide (NO), endothelin-1 (ET-1), vascular endothelial growth factor (VEGF)] and its flow-mediated endothelium-dependent vasodilation of the brachial artery (FMD), nitroglycerin mediated endothelium-independent vasodilation (NMD), oxidation-related substances (superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), reactive oxygen species (ROS) activity, and the concentration of malondialdehyde (MDA) were observed. The clinical efficacy was evaluated and the adverse reactions during the treatment were recorded.Results After treatment, FBG and PBG in the two groups were significantly lower (P＜0.05), but there was no significant difference in BMI between the two groups (P＞0.05).There was no significant difference in FBG, PBG or BMI between the two groups after treatment (P＞0.05). After treatment, SBP, DBP, ET-1, VEGF, ROS and MDA in the two groups were lower, and the difference was statistically significant (P＜0.05). After treatment, SBP, DBP, ET-1, VEGF, ROS and MDA in the observation group were significantly lower than those in the control group (P＜0.05). After treatment, NO, FMD, NMD, SOD and GSH-Px in the two groups were higher. The difference was statistically significant (P＜0.05). After treatment, NO, FMD, NMD, SOD and GSH-Px in the observation group were significantly higher than in the control group (P＜0.05). There was no serious adverse reaction (AEs) in either group, but such mild gastrointestinal reaction as rash and dry cough occurred in both groups, and there was no significant difference in the incidence between the two groups.Conclusions On the basis of hypoglycemic and hypotensive treatment, alprostadil can improve vascular endothelial function, improve the imbalance between oxidation and antioxidation, and improve the clinical effect in patients with T2DM complicated with hypertension without microangiopathy in the early stage.