高血压伴胰岛素抵抗患者非对称性二甲基精氨酸与颈动脉硬化的关系

目的 观察高血压伴胰岛素抵抗患者颈总动脉内膜中膜厚度和斑块的变化,探讨非对称性二甲基精氨酸与胰岛素抵抗及颈动脉粥样硬化的关系.方法 选择原发性高血压患者60例,根据HOMA指数分为伴胰岛素抵抗组35例和无胰岛素抵抗组25例;另选择20例作为正常对照组.测定血清胰岛素、非对称性二甲基精氨酸水平,检测颈总动脉内膜中膜厚度及斑块.结果 高血压伴胰岛素抵抗组颈总动脉内膜中膜厚度高于高血压无胰岛素抵抗组和正常对照组,高血压伴胰岛素抵抗组颈动脉斑块发生率高于正常对照组(P均<0.05);高血压伴胰岛素抵抗组血清非对称性二甲基精氨酸水平显著高于高血压无胰岛素抵抗组和正常对照组,高血压无胰岛素抵抗组血清非对称性二甲基精氨酸水平显著高于正常对照组(P均<0.05);在高血压患者中,直线相关分析显示颈总动脉内膜中膜厚度和血清非对称性二甲基精氨酸均与HOMA指数正相关(r=0.306和r=0.370,P<0.01).血清非对称性二甲基精氨酸与颈总动脉内膜中膜厚度正相关(r=0.381,P<0.01);多元逐步回归显示非对称性二甲基精氨酸是颈总动脉内膜中膜厚度增厚的独立危险因素.结论 血清非对称性二甲基精氨酸水平升高与高血压伴胰岛素抵抗状态下早期动脉粥样硬化的形成有关.

The Association Between Asymmetric Dimethylarginine and Carotid Atherosclerosis in the Patients with Hypertension and Insulin Resistance

Aim To observe the carotid intima-media thickness (IMT) and plaque in patients with hypertension and insulin resistance. Furthermore to investigate the correlation between asymmetric dimethylarginine (ADMA) and carotid atherosclerosis in patients with insulin resistance. Methods Sixty patients with essential hypertension were recruited. According to the level of homeostasis model assessment (HOMA),thirty-five patients were classified as essential hypertension with insulin resistant (EH with IR),and twenty-five as essential hypertension without insulin resistant (EH without IR). Another 20 healthy individuals were selected as the control groups. HOMA-IR was calculated as a measure of insulin resistance. Serum concentrations of ADMA levels were measured by the high-performance liquid chromatography method. Carotid IMT and plaque were measured by high-resolution ultrasonography. Result Common carotid artery IMT(CCA-IMT) in patients of EH with IR were higher than those in EH without IR and controls (P<0.05,P<0.01),the incidence of carotid plaques was also higher than that in controls (P<0.05). Serum levels of ADMA were significantly increased in EH with IR as compared with those in EH without IR and controls (P<0.01),the levels of ADMA in EH without IR were much higher than those in controls (P<0.01). In patients with hypertension,both CCA-IMT and serum levels of ADMA had positive correlations with insulin resistance (r=0.306 and r=0.370,P<0.01). Serum levels of ADMA closely correlated with the CCA-IMT (r=0.381,P<0.01),and this correlation remained significant even on multiple regression analysis. Conclusion Increased serum ADMA level may play a role in progression of early atherosclerosis in patients of hypertension with insulin resistance.