高血压合并糖尿病患者血浆内皮素变化及相关因素

Change of plasma endothelin and related factors in hypertensive patients with diabetes mellitus

目的:探讨高血压合并糖尿病患者的血浆内皮素与血糖、空腹胰岛素、血压、体质量指数等指标之间的相关性及其意义,以期为高血压并发症的康复预防提供量化依据。方法:选择2003-05/2003-12中国医科大学附属第一医院内科住院的高血压患者158例为研究对象,随机将其分为单纯高血压组(n=43),高血压合并糖耐量减低impairedglucosetolerance,IGT)组((n=77),高血压合并糖尿病组n=38);选择同期在中国医科大学附属第(一医院体检的健康人42例作为对照组。采用放射免疫法,测定研究对象血浆内皮素,血胰岛素,血糖,血压,身高,体质量等指标。结果:高血压合并糖尿病患者的血浆内皮素水平犤(190.44±34.76)ng/L犦明显高于单纯高血压组犤(97.97±9.19)ng/L犦和高血压合并IGT组犤(143.21±11.30)ng/L犦(P<0.05)。高血压合并糖尿病患者胰岛素抵抗指数(HOMA-IR)明显高于单纯高血压组和高血压合并IGT组P<0.05)。单纯高血压组空腹胰岛素、空腹血糖、餐后2h(血糖水平明显低于高血压合并糖尿病组(P<0.05)。高血压合并糖尿病患者血浆内皮素水平与体质量指数、腰围、餐后2h血糖、空腹胰岛素、HOMA-IR、收缩压呈显著正相关(r=0.556,0.423,0.658,0.665,0.651,0.465,P<0.05)。结论:高血压患者血浆内皮素水平升高。

AIM:To investigate the relationship of plasma endothelin(ET) with blood glucose, fasting insulin(FINS),blood pressure(BP),body mass index(BMI) and other indexes in hypertensive patients with diabetes mellitus(DM),and study the significance,so as to provide quantitative evidence for the rehabilitative prevention of hypertensive complications. METHODS:Totally 158 inpatients with hypertension,who were hospitalized in the Department of Internal Medicine,the First Affiliated Hospital of China Medical University from May to December 2003,were randomly divided into hypertension group(n=48),hypertension+ impaired glucose tolerance(IGT) group(n=77) and hypertension+ DM group(n=38),and another 42 healthy physical examinees at the same period in this hospital were taken as the controls.The levels of plasma ET,blood insulin,blood glucose,BP,body height and BMI were measured by using radioimmunoassay. RESULTS:The plasma ET level was obviously higher in the hypertension+ DM group[(190.44± 34.76) ng/L] than in the hypertension group[(97.97± 9.19) ng/L] and hypertension+ IGT group[(143.21 ± 11.30) ng/L] (P< 0.05).Homeostasis model assessment insulin resistance(HOMA IR) in the hypertension+ DM group was remarkably higher than those in the hypertension group and hypertension+ IGT group(P< 0.05). The levels of FINS,fasting blood glucose and postprandial 2 hour blood glucose were significantly higher in the hypertension group than in the hypertension+ DM group(P< 0.05).The plasma ET level of patients in the hypertension+ DM group had significantly positive correlation with BMI,waist circumference,postprandial 2 hour blood glucose,FINS, HOMA IR and systolic blood pressure(SBP) (r=0.556,0.423,0.658,0.665,0.651,0.465,P< 0.05). CONCLUSION:The plasma ET level is increased in patients with hypertension,and the increase is the most obvious in hypertensive patients with DM.The plasma ET level of hypertensive patients with DM is correlated with many factors.