瘦素、RAAS与高血压的关系

目的 探讨瘦素和肾素-血管紧张素-醛固酮系统（RAAS）与高血压的相互关系及病理生理机制.方法 采用放射免疫方法测定91例高血压患者及67名健康志愿者的血清瘦素、血浆肾素活性（PRA）、血管紧张素Ⅱ（AngⅡ）和醛固酮（ALD））水平;同时测量身高、体重,计算体质指数（BMI）.结果 ①同组内女性瘦素水平均显著高于男性（P＜0.01）;高血压组女性瘦素水平显著高于正常组女性（P＜0.01）;高血压组男性瘦素水平也显著高于对照组男性（P＜0.05）.②高血压患者血清瘦素、PRA、收缩压（SBP）和舒张压（DBP）均显著高于对照组（P＜0.01）; AngⅡ水平也明显高于对照组（P＜0.05）,而BMI和ALD水平与对照组比较无明显变化.③直线相关统计分析显示,高血压组患者血清瘦素的升高与PRA、AngⅡ、BMI和SBP呈正相关（PRA：r =0.52,P＜0.01;AngⅡ：r=0.43,P＜0.01;BMI：r =0.55,P＜0.01;SBP：r=0.33,P＜0.05）,而与ALD和DBP无相关性;对照组瘦素仅与BMI呈高度正相关（r=0.54,P＜0.01）,其它指标均无相关性.结论 血清瘦素水平对血压的影响与性别有关,高血压患者存在瘦素抵抗,瘦素可通过影响RAAS的活性使血压升高,主要为收缩压（SBP）的增高.

Relationship Between Serum Leptin Level and RAAS with Essential Hypertension

Objective To explore the relationship between serum leptin and renin-angiotensin-aldosterone system （RAAS） with essential hypertension,as well as pathophysiological mechanisms.Methods The serum leptin,plasma rennin activity （PRA）,angiotensin Ⅱ （Ang Ⅱ） and aldosterone （ALD） wwere measured by radioimmunoassay in 91 patients with essential hypertension and 67 healthy volunteers.Their body height and weight were measured,and the body mass index （BMI） was calculated.Results The serum leptin concentration was significantly higher in female than in male among the same group （P 〈 0.01）.The leptin levels in hypertension women patient group were significantly higher than those of the normal women group （P 〈0.01）.The leptin levels of hypertension men patient group were also significantly higher than those of the normal men group （P 〈0.05）.The leptin levels,PRA,systolic blood pressure （SBP） and diastolic blood pressure （DBP）in patient of primary hypertension were significantly higher than those in the control group （P 〈 0.01）.Serum concentrations of Ang Ⅱ were also much higher than those in healthy volunteers （P 〈 0.05）.Two groups did not differ in BMI and ALD.The correlation analysis showed that the serum leptin in patients of primary hypertension group was positively correlated with PRA,Ang Ⅱ,BMI and SBP （PRA：r =0.52,P 〈0.01 ; Ang Ⅱ：r =0.43,P〈0.01; BMI：r =0.55,P〈0.01; SBP：r =0.33,P〈0.05）,but not with ALD and DBP.The leptin in the control group was only positively correlated with BMI （r =0.54,P 〈 0.01）,but not with others.Conclusion The effect of serum leptin levels on blood pressure is related with gender.Leptin resistance exists in patients with primary hypertension.Leptin could cause an increase of blood pressure,especially SBP,in primary hypertension patients by regulating the activeness of RAAS.