高血压病患者不同左室构型与胰岛素抵抗的相关性

目的探讨高血压患者胰岛素抵抗对左室构型的影响。方法对高血压组164例进行常规心脏超声、空腹葡萄糖（FBG）、空腹胰岛素（FIN）、血脂检查。采用胰岛素敏感指数（HOMA-IR）作为评价胰岛素抵抗指标,按Gnanu分类法将高血压组划分为正常构型、向心性重构组、向心性肥厚组和离心性肥厚组。采用组间比较、相关性分析等统计学方法进行评价。结果高血压患者按左室重量指数（LVMI）分组,两组间空腹胰岛素及胰岛素抵抗差异无统计学意义（P〉0.05）;但按相对室壁厚度（RWT）分组,空腹胰岛素及胰岛素抵抗差异具有统计学意义（P〈0.05）。并且向心性重构组和向心性肥厚组明显高于正常构型组（P〈0.05）,而离心性肥厚组与正常构型组比较差异无统计学意义（P〉0.05）。逐步回归分析显示LVMI与体重指数、收缩压和舒张压呈正相关（P〈0.05～P〈0.01）,RWT与HOMA-IR呈负相关（P〈0.05）。结论胰岛素抵抗可能是高血压患者合并左室肥厚的重要影响因素之一,改善胰岛素抵抗有利于高血压患者左室肥厚的防治。

Relationship of Left Ventricular Geometry and Insulin Resistance in Essential Hypertension

Objective To investigate the effect of insulin resistance on left ventricle geometry.Methods Echocardiography,fasting serum glucose,fasting serum insulin and blood lipids were measured and the insulin sensitivity was calculated in 164 patients with essential hypertension.A total of 164 patients with essential hypertension were divided into normal geometry group,concentric remodeling group,concentric hypertrophy group and eccentric hypertrophy group.The corresponding data were compared by means of statistic among the groups.Results According to left ventricular mass index（LVMI）,there was no difference in the fasting serum glucose and the insulin resistance（P〉0.05）.According to relative wall thickness（RWT）,there were considerable differences in the fasting serum glucose and the insulin resistance（P〈0.05）.The normal geometry group,the fasting serum glucose and the insulin resistance in the concentric remodeling group and concentric hypertrophy group were higher（P〈0.05）.There was no difference in eccentric hypertrophy group（P〉0.05）.Multiple stepwise regression analysis showed that LVMI was positively correlated with body mass index（BMI）,systolic blood pressure and diastolic blood pressure（P〈0.05～P 〈0.01）,only HOMA-IR was independently correlated with RWT（P〈0.05）.Conclusion Insulin resistance may play an important role in the left ventricular hypertrophy of essential hypertension.It is helpful in the prevention and the cure of left ventricular hypertrophy of essential hypertension by improving insulin resistance.