有家族史的原发性高血压患者冠状动脉病变与胰岛素抵抗的相关性

Impact of Family History of Hypertension on Coronary Atherosclerosis in Hypertension Patients

目的 研究高血压家族史对原发性高血压患者的冠状动脉病变有无影响及冠状动脉病变与胰岛素抵抗的相关性。方法 对160例预行冠状动脉造影检查且符合原发性高血压的患者进行问卷调查,按有无家族史分为:(1)有家族史的高血压病组 72 例;(2)无家族史的高血压病组 88 例。每位患者均测量空腹胰岛素浓度及做冠状动脉造影检查。结果 有家族史的高血压病组的空腹胰岛素浓度、胰岛素抵抗指数、甘油三酯浓度明显的大于无家族史的高血压组(P<0 .01);有家族史的高血压病组有冠状动脉病变的比例达73. 7%,而无家族史组为58. 0%,两组比较有显著性差异,并且有家族史的高血压病组冠状动脉病变的平均累积积分明显大于无家族史的高血压病组(P<0 .01);有家族史的高血压病组的年龄、腰围、收缩压(SBP)、空腹胰岛素浓度(FINS)、胰岛素抵抗指数(IR)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL- C)的 OR值有统计学意义,而无家族史的高血压病组在年龄、SBP、TC、HDL- C、LDL -C的 OR值上有统计学意义。结论 高血压家族史是原发性高血压患者冠状动脉病变的重要预测因子,可能与有高血压家族史的原发性高血压患者代谢紊乱更严重,以及高胰岛素血症或胰岛素抵抗更明显有关。

Objective To study the impact of family history of hypertension on coronary atherosclerosis. Methods One hundred sixty hypertension patients were enrolled and divided into two groups based on family history of hypertension: group 1 with positive family history(n=72). group 2 with negative hypertension family history (n=88). Questionnaire, fasting insulin and coronary arteriongraphy were carried out in all patients. Results Patients in group 1 had higher fasting insulin, insulin resistance index and serum triglyceride in related to group 2 (P<0.01). The incidence rate of coronary arteriosclerosis was 73.6% in group 1 as compared with 58.0% in group 2(P<0.01). The average integral scores of coronary atherosclerosis were markedly greater in group 1 versus group 2 (5.7±2.4 vs 3.2±1.8,P<0.01). Conclusion Family history of hypertension may be an important risky factor on coronary heart disease ascribing to more pronounced metabolic disorder, hyperinsulinism or insulin resistance in hypertension patients with family history.