伴胰岛素抵抗高血压患者中的红细胞胰岛素受体  

Insulin Receptors in Erythrocytes in Essential Hypertension with Insulin Resista nce

作　　者：戴秋艳[1] 孙宝贵[1] 何奔[1] 吴莹[1] 汪玮[1] 郭冀珍[2] 

机构地区：[1]上海交通大学附属第一人民医院心内科,上海200080 [2]上海瑞金医院高血压科,上海200025

出　　处：《高血压杂志》2004年第5期411-414,共4页Chinese Journal of Hypertension

基　　金：上海市医学发展基金重点研究课题 ( 2 0 0I ZD0 0 1)

摘　　要：目的　研究伴胰岛素抵抗 (IR)的原发高血压患者 (EH)及治疗前后红细胞胰岛素受体(EIR)变化的意义。方法　 (1)伴IR的EH患者 37例 (男 2 5例 ,女 12例。平均年龄 (6 0± 6 .7)岁 ,健康对照 30例 (男 19例 ,女 11例。平均年龄 (6 2± 7.5 )岁的红细胞胰岛素低亲合受体结合位数EIR(RT2 )及相关指标 ,并计算胰岛素敏感性指数 (ISI)。 (2 )伴IR的EH患者分别给予三种不同治疗方案 (组 1:11例 ,福辛普利 5～ 2 0mg ,QD ;吲达帕胺 2 .5mg ,QD。组 2 :12例 ,阿替洛尔 12 .5～ 5 0mg ,QD ;尼群地平 10～ 2 0mg ,Bid。组 3:14例 ,阿替洛尔 12 .5～ 5 0mg ,QD ;尼群地平 10～ 2 0mg ,Bid ;二甲双胍 2 5 0mg ,Tid) ,疗程 1年 ,治疗前后观察EIR(RT2 ) ,ISI ,及相关指标的变化。结果　 (1)EH组EIR(RT2 ) ,ISI较对照组明显降低 (P <0 0 1)。相关分析显示 ,EIR与ISI、餐后 2h血糖正相关 ;与收缩期血压、血浆餐后两小时胰岛素水平 (IN)及甘油三酯 (TG)呈负相关。 (2 ) 3组治疗 ,血压控制均良好。 3组间无统计学差异。治疗前 :组 3RT2 低于组 1、2 ,有统计学差异 (P <0 0 1) ;组 1、2间无差异。治疗后 :组 3RT2 、ISI明显高于治疗前。结论　胰岛素受体水平下调是伴胰岛素抵抗高血压患者关键环节。红细胞胰岛素受体一定程?Objective To study the significance in insulin receptor in erythrocytes(EIR)in essential hypertension (EH) with insulin resistance (IR). Method EIR and insulin sensitivity index (ISI) were determined in 37 EH patients with IR before and after three kinds of treatments with 30 healthy subjects served as controls. Group 1 comprised of 1 1 patients treated with fosinopril 5-30 mg/d + indapamide 2.5 mg/d; group 2 of 1 2 patients treated with atenolol 12.5-5 mg/d+nitrendipine 10-20 mg bid+dimethylb iguanide hydrochloride 250 mg/d. Results In patients with EH, EIR and ISI were lower than those in healthy controls(P<001. EIR positively correlated with ISI and 120 min blood glucose after 75 g glucose loading, while negatively related to SBP, and 120 min plasma insulin after glucose load and pla sma triglyceride. Although, low affinity insulin receptor (RT\-2) in group 3 wa s lower than those in group 1 and 2 before treatment; however, it was significan tly increased after biguanide treatment. Conclusion Down regulatio n of insulin receptors might be a key factor in the mechanism by which the patie nts of essential hypertension developed insulin resistance. Erythrocytes insuli n receptor appears to be a useful, adjunctive marker to estimate the severity of insulin sensitivity. Dimethylbiguanide wa effective in the treatment of hypert ensives with insulin resistance.

关 键 词：胰岛素抵抗 高血压 红细胞胰岛素受体 治疗 

分 类 号：R544.1[医药卫生—心血管疾病]