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【medical-news】对于糖尿病患者发生的慢性心力衰

For CHF in Diabetics, Eplerenone May Be Better Than Spironolactone
对于糖尿病患者发生的慢性心力衰竭,依普利酮可能比螺内酯更好
NEW YORK (Reuters Health) Dec 06 - The mineralocorticoid receptor blocker eplerenone has metabolic advantages over spironolactone in the treatment of chronic heart failure (CHF), a Japanese team reports. In particular, eplerenone does not increase hemoglobin A1c levels, suggesting it may be useful in heart failure patients with diabetes.
纽约(路透社健康频道)12月06 - 盐皮质激素受体阻断剂依普利酮在慢性心力衰竭(CHF)时与螺内酯相比具有代谢优势,一个日本小组报告说。特别是,依普利酮不增加糖化血红蛋白A1c的水平,这表明它在合并糖尿病的心力衰竭患者或许有用。
The authors note in the November issue of the American Heart Journal that HbA1c levels have recently been tied to increased mortality in both diabetic and nondiabetic CHF patients, "suggesting the important role of insulin resistance in CHF." Also, they point out, cortisol is a risk factor for cardiovascular complications and it impairs insulin secretion.
作者在11月份出版的《美国心脏病杂志》上指出,最近研究表明糖化血红蛋白水平水平与糖尿病和非糖尿病心衰患者的死亡率紧密相关,“提示胰岛素抵抗在慢性心力衰竭方面的重要作用”。此外,他们指出,皮质醇是心血管并发症的一个危险因素,它损伤胰岛素的分泌。
Dr. Takayoshi Tsutamoto and colleagues at Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Japan, conducted a randomized trial to compare the effect of eplerenone and spironolactone on HbA1c and cortisol, as well as other parameters, in 107 patients with mild CHF who were already receiving standard therapy.
日本Shiga University医学科学系的Takayoshi Tsutamoto博士及其同事在107例轻度心衰的患者中进行了一项随机试验,比较了在标准治疗的基础上依普利酮和螺内酯对糖化血红蛋白和皮质醇的影响。
Seventy-three patients received eplerenone 50 mg/d; the other 34 received spironolactone 25 mg/d.
73例患者接受了依普利酮50 mg/d,其他34例患者用螺内酯25 mg/d治疗。
After four months of treatment, plasma B-type natriuretic peptide (BNP) levels decreased significantly by 29.9 pg/mL in the spironolactone group and by 20.7 pg/mL in the eplerenone group -- a nonsignificant difference. The increase in aldosterone was also not significantly different between the two groups (37.4 vs 46.3 pg/mL).
经过4个月的治疗,血浆B型利钠肽(BNP)水平在螺内酯组显著下降了29.9 pg/mL,在依普利酮组下降了20.7 pg/mL,两组间无显着性差异。两组间醛固酮增加也没有显着差异(37.4 vs 46.3 pg/mL)。

However, in the spironolactone group, plasma adiponectin levels decreased significantly from 12.6 to 11.2 mcg/mL, HbA1c increased significantly from 5.61% to 5.8%, and cortisol levels rose significantly from 11.3 to 14.7 mcg/dL. These parameters were essentially unchanged in the group receiving eplerenone.
然而,在螺内酯组,血浆脂联素水平从12.6 mcg/mL明显下降到11.2 mcg/mL,糖化血红蛋白从5.61%显着上升至5.8%,而皮质醇水平从11.3 mcg/dL显著上升至14.7 mcg/dL。这些参数在依普利酮组基本没有变化。
"These findings indicated that a selective MR blocker eplerenone was superior to spironolactone due to differences in metabolic effects especially those on HbA1c in CHF patients," Dr. Tsutamoto and colleagues conclude. "Compared with spironolactone, eplerenone may be more useful for treatment of CHF patients from the perspective of insulin resistance and cortisol levels, which were related to poor prognosis."
“这些结果显示,由于对代谢影响的差异特别是对CHF患者糖化血红蛋白的影响,选择性盐皮质激素受体阻断剂依普利酮优于螺内酯。”Tsutamoto博士及其同事总结道。 “与螺内酯相比,胰岛素抵抗和皮质醇水平的角度来看依普利酮可能更适合治疗慢性心力衰竭的患者,因为胰岛素抵抗和皮质醇与预后不良有关。”
Am Heart J. Posted November 2010.   
滨州医学院附属滨州市人民医院内分泌科 王新军 译 急性冠脉综合征介入治疗与保守治疗的评价 - 中医 - 鸭绿江文献...发表时间:2006-12-15回帖数:8急性冠脉综合征介入治疗与保守治疗的评价 首都医科大学附属北京安贞医院 马长生 ... 010例老年慢性心力衰竭患者随机分组,先用比索洛尔或依那普利治疗6个月,然后合用两药18个...forum.e2002.com/viewthread.... - 2007-12-01-快照-[标签:content2]

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作者:admin@医学,生命科学    2011-01-28 05:27
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