心室重塑患者瘦素抵抗与胰岛素抵抗及其相关性研究  

The Relationship Between Plasma Leptin Resistance and Insulin Resistance in Patients With Ventricular Remodeling

作　　者：武力勇[1] 王先梅[1] 杨丽霞[1] 齐峰[1] 郭传明[1] 周靓[1] 徐亮[1] 

机构地区：[1]成都军区昆明总医院心血管内科,云南省昆明市650032

出　　处：《中国循环杂志》2011年第1期30-33,共4页Chinese Circulation Journal

基　　金：云南省自然科学基金项目资助(项目名称:EGF受体的激活在瘦素诱导的内皮素-1表达中的作用;项目编号:2008ZC078M)

摘　　要：目的:探讨不同基础病因的心室重塑患者血浆瘦素、可溶性瘦素受体水平的改变及其与胰岛素抵抗的关系。方法:选择心室重塑患者(心室重塑组,n=180)和体检正常者(对照组,n=60)采用酶联免疫吸附法测定血浆瘦素及可溶性瘦素受体、空腹胰岛素的浓度,同时常规测空腹血糖、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、体重指数、腰臀比等指标。采用彩色多普勒超声诊断仪测量心室重塑患者左心室舒张末期间隔厚度、左心室后壁厚度、左心室舒张末期内径及左心室射血分数值,计算左心室质量指数。结果:心室重塑组血浆瘦素、空腹胰岛素均高于对照组[(12.22±6.10)ng/ml vs(8.89±5.27)ng/ml,P<0.01];[(14.37±7.19)ng/ml vs(10.48±5.17)ng/ml,P<0.01],可溶性瘦素受体水平低于对照组[(124.08±62.12)ng/mlvs(164.23±69.60)ng/ml,P<0.01],差异均有统计学显著意义;其中缺血性心肌病患者血浆瘦素和空腹胰岛素水平最高,较高血压性心脏病和扩张型心肌病患者差异有统计学显著意义(P<0.01)。可溶性瘦素受体呈现相反的变化,以对照组最高,其次为扩张型心肌病、高血压性心脏病和缺血性心肌病患者。结论:心室重塑患者存在高胰岛素血症和胰岛素抵抗。瘦素抵抗和胰岛素抵抗与心室重塑密切相关。Objective：To explore the relationship between plasma leptin and soluble leptin receptor （SLR） with insulin resistance in patients with ventricular remodeling（VR）. Methods： Our study consisted of two groups ,VR group ,n = 180 ,the patients had ventricular remodeling caused by different diseases, and Control group, n = 60 of healthy subjects. Fasting plasma leptin, SLR and insulin were examined by ELLS＆ Left ventricle diastasis interventricular septal thickness,posterior left ventricular wall thickness,left ventricle inner diastasis diameter and left ventricular ejection fraction were measured by color Doppler echocardiography and left ventricular mass index was calculated. Results： The levels of plasma leptin and insulin were significantly higher in VR group than that in Control group （12. 22 ± 6. 10 ） ng/ml vs. （ 8. 89±5.27 ） ng/ml, and （ 14. 37 ± 7.19 ） ng/ml vs. （ 10. 48 ± 5.17 ） ng/ml, P 〈 0.01 respectively ; SLR was lower in VR group than that in Control group （ 124. 08 ± 62. 12） ng/ml vs. （ 164. 23 ± 69. 60） ng/ml, P 〈 0. 01. The highest plasma level of leptin and insulin were found in patients with ischemic eardiomyopathy compared with the patients of hypertensive heart disease and dilated cardiomyopathy,P 〈 0. 01. While the highest level of SLR was found in Control group,followed by the patients with dilated cardiomyopathy,hypertensive heart disease and isehemic eardiomyopathy. Conclusion： Patients with VR suffered from high plasma insulin and insulin resistance. Leptin resistance and insulin resistance closely related to the ventricular remodeling.

关 键 词：心室重塑 瘦素 可溶性瘦素受体 胰岛素抵抗 

分 类 号：R544[医药卫生—心血管疾病]