原发性高血压患者脂肪餐负荷后甘油三酯代谢变化与胰岛素抵抗关系的评价

Relationship Between Postprandial Abnormal Serum Triglyceride Metabolism and Insulin Resistance in Hypertensive Patients

目的探讨原发性高血压患者脂肪餐负荷后甘油三酯(TG)代谢变化与胰岛素抵抗(IR)的关系。方法20例健康人(正常对照组)、32例超重/肥胖高血压患者(超重/肥胖高血压组)和33例正常体重高血压患者(正常体重高血压组)禁食12小时后,进行标准脂肪餐负荷试验,以TG8小时曲线下面积(TGAUC)和TG峰反应(TGPR)作为标准脂肪餐负荷后TG反应水平的指标。用稳态模式评估法的胰岛素抵抗指数(HOMAIR)作为评价胰岛素抵抗的指标。结果①超重/肥胖高血压组和正常体重高血压组TGAUC、TGPR均显著高于正常对照组(P<005),超重/肥胖高血压组TGAUC、TGPR显著高于正常体重高血压组(P<005)。②超重/肥胖高血压和正常体重高血压组HOMAIR均显著高于正常对照组(P<005),超重/肥胖高血压组HOMAIR显著高于正常体重高血压组(P<005)。③超重/肥胖高血压组和正常体重高血压组中具有IR的患者TGAUC、TGPR显著高于无IR的患者(P<001),而上述两组中无IR患者TGAUC、TGPR与正常对照组比较,无显著差异(P>005)。④TGAUC、TGPR与HOMAIR、空腹TG水平、舒张压、体重指数呈正相关。多因素回归分析显示HOMAIR是TGAUC、TGPR最重要的影响因素。结论原发性高血压患者存在脂肪负荷后TG代谢异常,肥胖和高血压对脂肪负荷后TG代谢异常及IR有协同作用。

Objective: To investigate the relationship between insulin resistance and postprandial abnormal serum triglyceride metabolism in hypertensive(HT) patients Methods:In normal subjects (NS, n =20),hypertensive non overweight /obesity patients (HT+non overweight/obesity, n = 33), or hypertensive and overweight/obesity patients (HT+overweight/obesity, n =32),standardized fat loading tests were measured 12 hours after fasting Triglyceride peak response(TGPR) and the area under triglyceride curve(TG AUC) over 8 hours were taken as the index of abnormal TG metabolism Homeostasis model assessment insulin resistance index (HOMA IR) was applied to estimate insulin resistance Results: ①Compared with those in NS group,TG AUC and TGPR were higher in HT+non overweight/obesity and HT+ overweight/ obesity ( p <0 05) TG AUC and TGPR in HT+overweight/obesity group were higher than those in HT+non overweight/obesity group( p <0 05) ②HOMA IR was higher in HT+overweight/obesity and HT+non overweight/obesity than that in NS group ( p <0 05), HOMA IR was higher in HT+overweight/obesity group than that in HT+non overweight/obesity group ( p <0 05) ③Patients with IR had higher TG AUC and TGPR than those with normal HOMA IR in HT+overweight/obesity and HT+non overweight/obesity group( p <0 01),and no significant diffrence was found between patients with normal HOMA IR and NS ( p <0 05) ④TG AUC and TGPR were positively related to HOMA IR, fastingTG, DBP, BMI The multivariate analysis showed that HOMA IR had the strongest effect on TG AUC and TGPR Conclusion: HT patients have postprandial abnormal serum triglyceride metabolism,HT and overweight/obesity have an aggravating effect on postprandial abnormal serum triglyceride metabolism and IR IR may play a leading role in postprandial abnormal serum triglyceride metabolism