高胰岛素血症与高血压病

INSULIN RESISTANCE AND HYPERTENSION

对２２例高血压病不伴糖尿病患者及１７例正常对照者行口服葡萄糖耐量试验（ＯＧＴＴ），同时测定血胰岛素、胆固醇、甘油三酯水平及红细胞膜钠一钾泵活性。结果显示原发性裔血压病患者有明显高脂血症、糖耐量异常及高胰岛素血症，这些变化符合Ｒｅａｖｅｎ提出的“×”综合征。统计学表明：在去除年龄、肥胖等因素影响后，舒张压（ＤＢＰ）和空腹、餐后３０ｍｉｎ胰岛素值及其曲线下面积（ＡＵＣ）仍呈正相关（Ｐ值均＜０．０３）；收缩压（ＳＢＰ）和ＤＢＰ都与钠一钾泵活性呈负相关（Ｐ值分别为＜００１、＜０．００１）；各期胰岛素值（０、３０、６０、１２０ｍｉｎ）及其ＡＵＣ与钠一钾泵活性亦均呈负相关（ｐ值均＜０．０５）。以上结果表明：胰岛素抵抗及其所致高胰岛素血症是导致“×”综合征的关键，也是促进原发性高血压病人冠心病发生与发展的因素之一，因而对高血压病人仅依靠有效降压治疗不一定能有效地控制冠心病的发生率，尚须对其高胰岛素血症予以控制。

n this study,we have measured plasma glucose and insulin levels at fasting and following an oral glucose load(75g) in 39 non-diabetic subjects(22 untreated hypertensive, 17 nonnotensive subjects)。We also assessed plasma cholesterol(Ch), triglyceride(TG) levels and Na￣+-K￣+-pump activity in the membranes of their erythrocytes.Overall,hypertensive subjects have hypcrcholesterol,hypertriglyceride,ducose intolerance and hyperinsulinemia,These changes accorded with Syndrome X proposed by Reaven. In multivariant analysis,after correcting for age,BMI,diastolic pressure(DBP)was positively related to fasting,1/ 2h insulin and insulin area under cure(AUC)(P<0.05).Both systolic pressure(SBP) and DBP were negatively correlated to Na￣+-K￣+-pump (P < 0.01、0.001),while Na￣+-K￣+-pump was negatively fasting、1/ 2h、1h、 2h insulin levels and insulin AUC (P<0.05,0.05,0.01,0.01, respectively).These results showed that insulin may affcct Na￣-K￣+-pump activity to develop hypertension indepedent of age and obese。We also postulated that insulin resistanee was causal in the syndrome X,also one of factors developing coronary artery disease。