原发性高血压患者血浆肾素活性、血管紧张素Ⅱ及醛固酮水平与胰岛素抵抗的关系  

Association of plasma renin activity, angiotensin Ⅱ and plasma aldosterone concentration with insulin resistance in patients with essential hypertension

作　　者：骆秦[1] 努尔古丽·买买提[2] 努尔布维·吐尔逊 王梦卉[2] 赵建雯 李南方[2] LUO Qin;NU ER GU LI·Mai mai ti;NU ER BUWEI·Tu er xun;WANGMenghui;ZHAO Jianwen;LI Nanfang(Xinjiang Medical University,Urumqi,830054,China;Hypertension Center,People’s Hospital of XinjiangUygur Autonomous Region,Hypertension Institute of XinjiangUygur Autonomous Region,Urumqi,830001,China)

机构地区：[1]新疆医科大学,乌鲁木齐830054 [2]新疆维吾尔自治区人民医院高血压诊疗中心、新疆高血压研究所,乌鲁木齐830001

出　　处：《新疆医学》2019年第6期555-558,565,共5页Xinjiang Medical Journal

基　　金：国家自然科学基金（项目编号：81660139）

摘　　要：目的本研究旨在分析原发性高血压(EH)患者的血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)及血浆醛固酮浓度(PAC)与胰岛素抵抗相关指标之间的关系,明确EH患者肾素-血管紧张素系统(RAS)活性与胰岛素抵抗(IR)的关系。方法回顾2009年1月-2011年12月在新疆维吾尔自治区人民医院高血压诊疗中心住院,经过规范化高血压病因筛查及诊断流程、明确诊断为EH的患者,将172例同期完善了标准状态下PRA、AngⅡ、PAC测定及口服葡萄糖耐量试验(OGTT)、胰岛素释放试验的EH患者纳入分析,采用改良的稳态模型评估(HOMA2)计算器计算反映胰岛素抵抗水平的相关指标:胰岛素抵抗指数(HOMA2-IR)、胰岛素敏感指数(HOMA2-S)及β细胞功能(HOMA2-β),分析PRA、AngⅡ、PAC与上述胰岛素抵抗指标之间的关系。结果PRA与空腹胰岛素水平(r=0.18,P=0.017)及HOMA2-IR(r=0.19,P=0.011)呈正相关,且对数线性模型拟合度最好(优于线性模型,P值分别为0.012、0.009);PRA与HOMA2-S呈负相关(r=-0.19,P=0.011);未发现AngⅡ、PAC与空腹胰岛素及HOMA2-IR存在相关性。将研究对象按PRA水平分为正肾素组(PRA≥1.0 ng/mL/h)与低肾素组(PRA<1.0 ng/mL/h),结果显示:与低肾素组相比,正肾素组患者的空腹胰岛素水平(14.3±10.6比10.5±5.9 mIU/L,P=0.008)及HOMA2-IR(平方根转换)(1.3±0.5比1.1±0.3,P=0.005)均明显升高。结论EH患者的肾素活性与胰岛素抵抗指数呈正相关,提示RAS激活与EH患者的胰岛素抵抗有关。Objective To analyze the association of plasm renin activity(PRA),angiotensinⅡ(AngⅡ)and plasma aldosterone concentration(PAC)with insulin resistance(IR)in patients with essential hypertension(EH)and to clarify the relationship between renin-angiotensin system(RAS)activity and IR.Methods 172 hypertensive patients who were hospitalized in hypertension center of People’s Hospital ofXinjiang Autonomous Region fromJanuary 2009 to December 2011 were included and underwent strict screening and diagnosis process of secondary hypertension and definitively diagnosed with EH.All patients performed PRA,AngⅡ,PAC in standard status and conducted oral glucose tolerance test(OGTT)and insulin releasing test.Indicators of IR,homeostatic model assessment of insulin resistance(HOMA2-IR),insulin sensitive index(HOMA2-S)and beta cell function(HOMA2-β),were calculated by updated HOMA2 calculator.Results PRA level was positively correlated with fasting insulin(r=0.18,P=0.017)and HOMA2-IR(r=0.19,P=0.011),log-linear model,which displayed the best fitting degree of the correlation(better than the linear model,and the P values were 0.012 and 0.009,respectively).PRA was negatively correlated with HOMA2-S(r=-0.19,P=0.011).No association was found in AngⅡ,PAC with fasting insulin and HOMA 2-IR.Moreover,in the normal or high renin(PRA≥1.0 ng/mL/h)patients,fasting insulin(14.3±10.6 vs 10.5±5.9 mIU/L,P=0.008)and Sqrt HOMA2-IR(1.3±0.5 vs 1.1±0.3,P=0.005)were significantly higher than those in patients with low renin(PRA<1.0 ng/mL/h).Conclusions Renin activity is positively correlated with insulin resistance indexes in EH patients,suggesting that RAS activation is correlated to insulin resistance.

关 键 词：原发性高血压(EH) 胰岛素抵抗(IR) 稳态模型评估胰岛素抵抗指数(HOMA2-IR) 血浆肾素活性(PRA) 血浆醛固酮浓度(PAC) 

分 类 号：R544.1[医药卫生—心血管疾病]