高血压病患者左室肥厚及构型改变与胰岛素抵抗的关系

目的:探讨高血压病(EH)患者胰岛素抵抗(IR)对左心室肥厚(LVH)和几何构型的影响。方法:检测124 例EH病人的左室重量指数(LVMI),相对室壁厚度(RWT),空腹血清葡萄糖(FSG)、空腹血胰岛素(FSI)浓度, 并计算胰岛素敏感性指数(ISI)。依照LVMI及RWT的数值124例EH病人被分为左室正常构型(51例),向心性构型(30例),向心性肥厚型(22例),离心性肥厚型(21例)。结果:RWT与年龄、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、平均心率呈正相关(r=0.16-0.22,P<0.05),与ISI呈负相关(r=-0.24),LVMI与SBP、DBP呈正相关(r=0.16-0.20,P<0.05),与ISI不相关。向心性重构组和向心性肥厚组年龄、RWT、HR、BMI大于正常构型组(P<0.05-<0.01),而ISI小于正常构型组(P<0.01)。结论:胰岛素敏感性降低与EH患者左心室肥厚无关,与RWT增加密切相关;ISI可能是EH患者发生左室向心性构型的重要影响因素之一。

Correlation of left ventricular hypertrophy and geometry with insulin resistance in essential hypertension

Objective: To investigate the effect of insulin resistance (IR) on the left ventricular (LV) hypertrophy and geometry. Methods:Left ventricular mass index (LVMI), relative wall thickness (RWT), fasting serum glucose and fasting serum insulin were measured and the insulin sensitivity (ISI) was calculated in 124 patients with essential hypertension (EH). Results:RWT was significantly related to age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) (r=0. 16-0. 22, P<0. 05), whereas ISI was inversely related to RWT (r= - 0. 24). Only SBP and DBF were significantly positive related to LVMI (r = 0. 16-0. 20. P< 0. 05). Comparing subjects with various LV geometies showed that age, RWT, HR and BMI were significantly higher (P<0. 05-<0. 01) and ISI was significantly lower (P<0. 01) in concentric remodeling geometry group and concen- tric hypertrophy geometry group than those in normal LV geometry group. Conclusion: Insulin resistance (related with ISI decrease) is related to concentric changes in LV geometry in essential hypertension.