高血压病患者左室几何构型与胰岛素抵抗关系的研究  

Correlation of left ventricular geometry with insulin resistance in essential hypertension

作　　者：史卫国[1] 强力[1] 丁灵芝[1] 孙鼎会[2] 

机构地区：[1]青岛市第八人民医院心内科,266100 [2]青岛市人民医院内科

出　　处：《中华心血管病杂志》2003年第5期353-356,共4页Chinese Journal of Cardiology

摘　　要：目的　探讨高血压病 (EH)患者胰岛素抵抗 (IR)对左室几何构型的影响。方法　依照左室质量指数 (LVMI)和相对室壁厚度 (RWT)将 118例EH患者分为左室正常构型组 (5 8例 )、向心性重构组 (2 2例 )、向心性肥厚组 (14例 )、离心性肥厚组 (2 4例 )。并行口服葡萄糖耐量试验和同步胰岛素释放试验 ,计算胰岛素敏感性指数 (ISI)、血糖曲线下面积 (AG)、胰岛素曲线下面积 (AI)、空腹血浆胰岛素 /空腹血糖 (FSI/FSG)比值、AI/AG比值。设对照组 86例。应用单元和多元回归分析观察RWT、LVMI与各胰岛素敏感性指标的关系。结果　与对照组比较 ,EH各左室构型组除FSG外 ,FSI、ISI、AG、AI、FSI/FSG、AI/AG差异均有显著性 (P <0 0 5～P <0 0 1) ,但各构型组间差异无显著性 (P >0 0 5 )。单因素相关分析显示EH组RWT与FSI、AG、AI、收缩压呈正相关 (r值分别为 0 193,0 196 ,0 2 36 ,0 183,P均 <0 0 5 ) ,与ISI呈负相关 (r值为 - 0 2 5 1,P <0 0 1) ,LVMI与体重指数、收缩压、舒张压呈正相关 (r值分别为 0 2 4 2 ,0 2 14 ,0 184 ,P <0 0 5～P <0 0 1) ,而与各胰岛素敏感性指标不相关 (P >0 0 5 )。逐步回归分析显示RWT与ISI呈独立相关 (R2 =0 0 6 3,P =0 0 0 6 )。结论　HIS及IR存在于EH患者各种左室几何?Objective To investigate the effect of insulin resistance (IR) on the left ventricular geometry in essential hypertension (EH). Methods According to relative wall thickness (RWT) and left ventricular mass index (LVMI), a total of 118 patients with EH were divided into normal geometry group (58 cases), concentric remodeling group (22 cases), concentric hypertrophy group (14 cases) and eccentric hypertrophy group (24 cases). The oral glucose tolerance test and insulin release test were performed in all patients and 40 healthy subjects . The area under glucose tolerance curve (AG), area under insulin release curve (AI), fasting serum insulin/fasting serum glucose (FSI/FSG) ratio, AI/AG ratio and insulin sensitivity index (ISI) were calculated. Eighty-six healthy subjects were recruited as controls. Correlations between RWT, LVMI and 7 insulin-sensitivity parameters were respectively obtained using linear regression analysis, and the stepwise regression analysis was used to assess the independent effect of each parameter. Results Compared with control group, FSI, AG, AI, FSI/FSG and AI/AG were higher ( P <0.05～ P <0.01) and ISI was lower ( P <0.01) in EH with different LV geometrical patterns , but no difference was observed among four LV geometrical patterns ( P >0.05). Correlation analysis showed that RWT was positively correlated with FSI, AG, AI and systolic blood pressure (SBP) ( r =0.193,0.196,0.236,0.183,respectively, all P <0.05), inversely correlated with ISI ( r =-0.251, P <0.01); LVMI was positively correlated with body mass index (BMI), SBP and diastolic blood pressure (DBP) ( r =0.242,0.214,0.184, respectively, P <0.05～ P <0.01), but not correlated with all insulin-sensitivity parameters ( P >0.05). Multiple stepwise regression analysis showed that only ISI was independently correlated with RWT (R 2=0.063, P =0.006) but not with LVMI. Conclusion Hyperinsulinemia and IR can occur in EH with all LV geometrical patterns. Decreased insulin sensitivity may be related to increased RWT and promote concentr

关 键 词：高血压 左室几何构型 胰岛素抵抗 相对室壁厚度 葡萄糖耐量试验 

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