肥胖高血压患者血清瘦素与肾素-血管紧张素-醛固酮系统及胰岛素相关性分析  

Relationship between Serum Leptin Level and RAAS,Insulin Sensitivity in Patients with Obesity-related Hypertension

作　　者：郝瑩[1] 臧彬[1] 

机构地区：[1]中国医科大学附属盛京医院心内科,辽宁沈阳110004

出　　处：《中国慢性病预防与控制》2008年第3期275-278,共4页Chinese Journal of Prevention and Control of Chronic Diseases

摘　　要：目的分析瘦素与肾素-血管紧张素-醛固酮系统(RAAS)、胰岛素的相关性,探讨瘦素在肥胖高血压患者发病中的病理生理机制。方法收集肥胖高血压患者38例,非肥胖高血压患者32例,肥胖者33例,健康对照者33例。测定瘦素、空腹胰岛素(FINS)、肾素(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)和空腹血糖(FPG),计算胰岛素敏感性指数(ISI)。测量身高、体重,计算体质指数(BMI)。结果肥胖高血压组、高血压组和肥胖组患者ISI均低于对照组(P<0.05)。肥胖高血压组、肥胖组患者瘦素水平高于对照组(P<0.05),肥胖高血压组患者瘦素水平高于肥胖组(P<0.05)。以瘦素为因变量进行多元逐步回归分析,发现影响血清瘦素水平的因素主要是性别、收缩压、BMI、ISI和PRA(r2=0.596,P<0.05)。各组患者瘦素水平均与ISI负相关(P<0.05)。肥胖高血压组患者瘦素水平与PRA、ALD正相关(P<0.05),高血压组患者瘦素水平与AngⅡ正相关(P<0.05),肥胖组患者瘦素水平与PRA正相关(P<0.05)。将肥胖高血压组和高血压组合并后,按PRA分为高肾素组(B组)、低肾素和正常肾素组(A组),B组患者瘦素水平高于A组(P<0.05)。结论肥胖者、肥胖高血压者均存在瘦素抵抗和胰岛素抵抗,二者相互作用。瘦素通过影响RAAS活性导致肥胖者血压增高,主要表现为收缩压升高,并且这一效应独立于胰岛素。Objective To analyze the relationship between serum leptin level and RAAS,insulin sensitivity.Methods We collected 38 patients with obesity-related hypertension,32 patients with hypertension,33 patients with obesity and 33 normal controls.Their serum levels of Leptin,FINS,PRA,AngⅡ,ALD and FPG were measured,and then the insulin sensitivity index（ISI） was calculated.Their body height and weight were measured,and body mass index（BMI） was calculated.Results ISI levels in patients with obesity-related hypertension,with hypertension or with obesity were significantly lower than that in the control（P〈0.05）.Serum leptin levels in patients with obesity-related hypertension or with obesity was significantly higher than that in the control（P〈0.05）.Serum leptin level in patients with obesity-related hypertension was also significantly higher than that in patients with obesity（P〈0.05）.In a multiple linear step-wise regression analysis with serum leptin level as dependent variable,we found that the gender,BMI,SBP,ISI and PRA were main influential factors for serum leptin level（r^2=0.596,P〈0.05）.There was a significantly negative correlation between serum leptin level and ISI in all four groups（P〈0.05）.Simple correlation analysis showed that there was significantly positive correlations between serum leptin level and PRA,ALD in patients with obesity-related hypertension（P〈0.05）,significantly positive correlation between serum leptin level and AngⅡ in patients with hypertension（P〈0.05） and significantly positive correlation between serum leptin level and ALD in patients with obesity（P〈0.05）.After patients with obesity-related hypertension and patients with hypertension combined into one group,they were divided into other three subgroups according to their PRA level,including normal PRA group,Low PRA group and high PRA group.We found serum leptin level of high PRA group was significantly higher than that of normal PRA group（P〈0.05）.Conclusions Leptin resistance and

关 键 词：高血压 肥胖症 瘦素 胰岛素 肾素-血管紧张素系统 醛固酮 

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