肥胖与高血压患者血清瘦素水平与胰岛素抵抗的相关性研究

目的探讨肥胖和高血压患者血清瘦素水平与胰岛素抵抗(IR)的关系及在肥胖和高血压发病机制中的作用。方法选择男性合并肥胖或非肥胖的高血压患者和正常血压者,测定血糖、胰岛素、血脂、尿酸(Ur)、胰岛素敏感性指数(ISI)、24h尿蛋白定量和血清瘦素浓度,分析瘦素水平与IR的相关性及与体重指数(BMI)、血压和其它各项指标的关系。结果血清瘦素水平在高血压组高于正常血压组,肥胖者高于非肥胖者。ISI则为正常血压组的非肥胖者高于肥胖者,而无论肥胖与否,正常血压组均高于高血压组。在高血压组中,ISI降低程度肥胖与非肥胖者无显著差异。在合并肥胖的高血压和正常血压组中,血清瘦素水平与ISI呈显著负相关(r=－0.51,P<0.01)和(r="－"0.38,P<0.05)。BMI、腰臀比、ISI是影响两组瘦素水平的最显著因素,影响ISI的因素依次为BMI、SBP、DBP、TG、Ur和瘦素。BMI是影响瘦素水平和ISI的共同因素。多元逐步回归分析发现,BMI与瘦素、ISI、TG密切相关。结论肥胖者血清瘦素水平升高与IR高度相关,并与脂代谢有关。瘦素抵抗在高血压的发生中可能起间接促进作用,但与IR的关联尚待探讨。

The relationship between serum leptin levels and insulin resistance in hypertensive and obesity patients.

Objective To investigate the relationship between serum leptin levels and insulin resistance(IR)in obesity and hypertensive patients and their role on the occurrence of hypertension or/and obesity.Methods Serum glucose,insulin,total cholesterol(TC),triglycerides(TG),HDL－ C,LDL－ C,uricacid(Ur),insulin sensitivity index(ISI),urinary albumin excretion(UAE)and serum leptin concentrations were determined in 66 men with essential hypertension and 67 male normotensives.The correlations between leptin and IR,and they and body mass index (BMI),blood pressure and other parameters were analyzed.Results Serum leptin levels were signifcantly higher in hypertensive and obesity subjects than in normotensive and nonobesity ones.ISI of nonobesity was higher than obesity in normotensive group,but both obesity and nonobesity ISI was higher in normotensive group than in hypertensive one .No significant change in obesity and nonobesity was found for the decreased levels and ISI(r=－ 0.51,P<0.01 and r="－" 0.38,P< 0.05,respectively ) and the most singificant factors that affected serum leptin levels were BMI,waist hip ratio and ISI and the factors that affected ISI in order of importance were BMI,SBP,DBP,TG,Ur and leptin in obesity subjects of both hypertensive and ISI in above mentioned patients.The multiple regression analysis indicated that BMI was closely correlated with leptin,ISI and TG in obesity patients of both hypertensive and normotensive groups. Conclusion The increase in serum leptin levels in obesity is highly correlated with ISI and is correlated with lipid metabolism.leptin resisitance may has a indirect action in occrrence of hypertension and the correlation with IR remain to be sutdied.