胰岛素抵抗在高血压病患者升压机制的探讨  

Possible mechanisms of hyperinsulinemia in enhancing blood pressure

作　　者：夏维波[1,2] 李长育[1,2] 宋光华[1,2] 叶建珏 

机构地区：[1]大连医科大学附属第二医院内科 [2]北京协和医院内分泌科

出　　处：《中华心血管病杂志》1997年第2期116-119,共4页Chinese Journal of Cardiology

摘　　要：观察了３３例高血压病病人和２５例正常对照者的血糖、胰岛素等生化指标以评价胰岛素敏感性，测定了红细胞胰岛素受体（ＥＩＲ）并分析其与胰岛素敏感性的关系。通过对血浆去甲肾上腺素、醛固酮和红细胞膜上离子泵活力的测定，及血压与上述诸因素的多元回归分析，探讨了高胰岛素血症致ＥＨ的可能机理。结果表明：高血压病人存在胰岛素抵抗（ＩＲ），ＩＲ可能与ＥＩＲ数目减少有关。高胰岛素血症可能是通过增加交感神经活性和醛固酮浓度，改变细胞膜上离子泵等途径致高血压的。The aims of the present study were to investigate the mechanisms of hyperinsulinemia in enhancing blood pressure. Thirty three patients with essential hypertension (EH) were included in the study and 25 healthy subjects were used as control. Serum glucose (SG), insulin, C peptide, HbA1c, insulin sensitive index (ISI), erythrocyte insulin receptors (EIR) and other metabolic parameters were determined. Serum nonepinephrine (NE), plasma aldosterone (ALD), the activities of (Na,K) ATPase and (Ca,Mg) ATPase on erythrocyte membrane were also measured in all 58 subjects. SG, insulin, HbA1c were significantly higher in the study group than the controls. However, ISI and high affinity binding site of EIR (R1) were significantly lower in EH patients than those in the controls. SG and R1 correlated negatively with insulin and positively with ISI. A regression equation was obtained by using blood pressure (BP) as dependent variable and other major parameters as independent variables. NE and ALD in EH were significantly higher and the activities of (Na,K) ATPase and (Ca,Mg) ATPase in EH were significantly lower than those in controls. The results suggest that enhancing activity of sympathetic nerves, increasing exchangeable sodium and activating the membrane ion pumps are possible mechanisms causing hypertension in patients with hyperinsulinemia.

关 键 词：高血压 高胰岛素血症 胰岛素抵抗 

分 类 号：R544.102[医药卫生—心血管疾病] R587.1[医药卫生—内科学]