高血压合并糖耐量减低患者血清瘦素水平与尿微量白蛋白的相关性

The Correlation between Leptin and Microalbuminuria in Hypertensive Patients with Impaired Glucose Tolerance

目的通过分析血清瘦素水平与尿微量白蛋白、体质指数、空腹胰岛素和稳态模型评价胰岛素抵抗指数等指标的相关性,探讨其在高血压合并糖耐量减低发生机制中可能起到的作用。方法采用放射免疫法检测198例高血压病患者和47例正常对照者的血清瘦素、尿白蛋白排泄率、空腹胰岛素、血清与尿β2微球蛋白等指标。结果女性血清瘦素水平显著高于男性(P<0.001)。高血压患者中糖耐量减低者的血清瘦素水平和尿白蛋白排泄率显著高于对照组(13.6±8.0μg/L比3.87±1.48μg/L和18.8±12.5μg/min比5.47±2.19μg/min,P<0.05)及糖耐量正常者(13.6±8.0μg/L比6.08±2.03μg/L和18.8±12.5μg/min比10.0±5.2μg/min,P<0.05),低于合并糖尿病者(13.6±8.0μg/L比16.6±8.7μg/L和18.8±12.5μg/min比30.5±12.3μg/min,P<0.05)。其中肥胖者的血清瘦素水平显著高于非肥胖者(15.1±9.0μg/L比11.6±6.0μg/L,P<0.05)。尿微量白蛋白者血清瘦素水平显著高于尿白蛋白正常者(16.0±9.9μg/L比11.7±5.6μg/L,P<0.05)。本实验在控制了性别和体质因素后,糖耐量减低组的血清瘦素水平与尿白蛋白排泄率(r=0.543,P<0.001)、尿β2微球蛋白(r=0.337,P<0.01)、血清β2微球蛋白(r=0.230,P<0.05)、脉压(r=0.364,P<0.001)、胰岛素抵抗指数(r=0.325,P<0.01)、空腹胰岛素(r=0.302,P<0.01)和收缩压(r=0.290,P<0.01)呈显著正相关。多因素Backward逐步回归分析表明,性别、尿白蛋白排泄率、胰岛素抵抗指数和脉压与血清瘦素相关最显著。结论性别和体质指数是影响瘦素水平的决定性因素。高血压患者中合并IGT的发生发展是多因素综合作用的结果,此阶段可能已存在早期肾功能损伤。

Aim To examine the association between serum leptin and microalbuminturia （MA）, body mass index （BMI）, fasting serum insulin （FINS）, homeostasis model assessment insulin resistance （HOMA-IR） and evaluate function of the correlation in mechanism of hypertension with impaired glucose tolerance （IGT）. Methods This study included 198 hypertonsives and 47 healthy subjects. Hypertensives were divided into 3 groups according to their glucose tolerance： NGT, IGT and DM groups. Serum leptin, urinary albumin excretion rate （UAER）, FINS, serum beta2-microglobulin （β2-MG）and urinary β2- MG concentrations were determined by radioimmunoassay. Results Baseline clinical characteristics of patients and the controls showed that serum leptin concentrations in females were significantly higher as compared with males （ P 〈 0.001）. In IGT group, serum lepfin levels and UAER were higher than in control group （13.6± 8.0 μg/L vs 3.87± 1.48 μg/L and 18.8± 12. 5 μg/min vs 5.47 ± 2.19 μg/min, P〈 0.05）and NGT group （13.6± 8.0 μg/L vs 6.08±2.03 μg/L and 18.8± 12.5 μg/min vs 10.0 ±5.2 pg/min, P 〈 0.05）, but lower than in DM group （ 13.6 ± 8.0 μg/L vs 16.6 ± 8.7 μg/L and 18.8 ± 12.5 μg/min vs 30.5±12.3μg/min, P〈0.05）. Serum leptin concentratiom of obese patients were higher than non-obese oncs （15.1±9.0 μg/L vs 11.6±6.0μg/L, P〈0.05）. Serum lepfin levels of patients with mieroalbuminmia were significanfly higher than subjects with nonnoalhaninmia（16.0±9.9μg/L vs 11.7±5.6μg/L, P〈0.05）. After adjusunent for sex and the degree of body fat mass, leptin was pcsifively correlated with UAER （ r = 0.543, P 〈 0.001 ）, urinary β2-MG （ r = 0.337, P 〈 0.01 ）, serum β2-MG （r=0.230, P〈0.05）, pulse pressure （r=0.364, P〈0.001）, HOMA-IR （r=0.325, P〈0.01）, FINS （r=0. 302, P 〈 0. 01 ） and systolic blood pressure （ r = 0. 290, P 〈 0. 01 ）. Multiple backward regression analysis showed sex, UAER, HOMA-IR and pulse pressure were significantly related to leptin. Conclusions Sex and BMI are the most significant determinants of serum leptin concentrations. The development of hypertension with IGT is decided by interrelafion of many factors, furthermore, renal function might have been damaged in this stage.