胰岛素抵抗与原发性高血压大动脉顺应性的相关性研究

目的 探讨胰岛素抵抗与原发性高血压(EH)患者大动脉顺应性的关系.方法 选取原发性高血压患者35例作为EH组,并选取性别、年龄、体重指数近似于EH组的血压正常的健康者35名作为正常对照组.均行血压测定和采用彩色多普勒超声心动图检测,并计算升主动脉压力应变弹性系数(EP)及动脉僵硬度(β)值作为反映大动脉顺应性的参数,采用氧化酶法测定空腹血糖(FPG),化学发光法测空腹胰岛素(FINS),计算胰岛素抵抗指数(HOMA-IR),2组进行比较研究.结果 EH组FINS为(10.15±1.03)mU/L,HOMA-IR为2.21±0.68,升主动脉EP为(250.79±85.52)kN/m2,升主动脉β值为15.60±7.55.正常对照组FINS为(6.80±3.05)mU/L,HOMA-IR为1.48±0.16,升主动脉EP为(183.90 4-64.65)kN/m2,升主动脉β值为10.86±4.92,2组比较差异均有统计学意义(t值分别为2.213、2.626、4.526和2.602,P均<0.05).EH组HOMA-IR与升主动脉EP、升主动脉β值均呈显著正相关(r值分别为0.558和0.601,P均<0.05).结论 原发性高血压患者存在大动脉顺应性减退及胰岛素抵抗,并且大动脉顺应性与胰岛素抵抗有明显相关性,与胰岛素抵抗相关的高胰岛素血症可能是促进原发性高血压患者发生大动脉重构的重要影响因素.

Associations of insulin resistance with the compliance of large artery in patients with essential hypertension.

Objective To study the association of insulin resistance ( IR ) with aortic compliance impairment in patients with essential hypertension (EH). Methods Thirty-five patients with EH and 35 healthy control subjects were enrolled. The two groups were matched by sex, age and weight Blood pressure was measured and high resolution color Doppler examination was performed. Pressure-strain elastic modulus ( EP) and stiff index were calculated to reflect the change of aortic compliance in all subjects. Fasting plasma glucose (FPG) was assayed with oxidase technique, serum fasting insulin ( Fins) was assayed with chemoluminescent technique, Calculate insulin resistance index (HOMA-IR) was calculated using FPG and FINS. Results In the EH group, Fins, HOMA-IR and EP of ascending aorta were ( 10. 15 ± 1.03) mU /L, 2. 21 ± 0. 68, (250. 79 ± 85. 52 ) kN/m2, respectively,and the stiff index( β) was 15. 60 ±7. 55. In the control group, Fins,HOMA-IR, EP and stiff index β were (6. 80 ± 3. 05) mU/L, 1. 48 ± 0. 16, (183. 90 ± 64. 65 ) kN/m2 and 10. 86 ± 4. 92, respectively. There were significant difference on these above mentioned indices between the two groups (P < 0. 05 ). In the EH group, HOMA-IR were positively correlated with the ascending aorta EP and stiff index β ( r = 0.558 and 0.601 respectively, P < 0. 05 ). Conclusions Aortic compliance impairment and IR are found in patients with EH. There is significant association of IR with aortic compliance impairment Hyperinsulinemia related to insulin resistance might be an important influential factor which promote large artery remodeling in patients with EH.