左室肥厚和胰岛素敏感性降低对高血压病患者冠状动脉血流储备的影响

Therelationshipbetwencoronarybloodflowreserveanddecreasedinsulinsensitivityinpatientswithhypertensiveleftventricularhypertrophy

为研究高血压左心室肥厚病人的冠状动脉血流储备（ＣＦＲ）与胰岛素敏感性降低（ＤＩＳ）的关系。经食管超声（ＴＥＥ）研究２０例正常人（ＮＳ），３２例高血压非左室肥厚病人（ＨＴ＋ｎｏｎＬＶＨ），３３例高血压左室肥厚病人（ＨＴ＋ＬＶＨ）的ＣＦＲ，用正常血糖胰岛素钳夹技术测定胰岛素敏感性。结果显示：（１）ＨＴ＋ＬＶＨ组Ｄ／ＲＰＤＶ，Ｄ／ＲＰＳＶ（１．７４±０．３７，１．６７±０．４１）较ＨＴ＋ｎｏｎＬＶＨ组（２．５６±０．４６，２．４５±０．４８）及ＮＳ组（２．６６±０．５８，２．３０±０．３７）明显减少（Ｐ＜０．０１），而ＮＳ，ＨＴ＋ｎｏｎＬＶＨ组无显著性差异。（２）合并ＤＩＳ的高血压病人ＣＦＲ减退发生率（７７．８％）较胰岛素敏感性正常的高血压病人高（２０．７％）（Ｐ＜０．０１）。（３）合并ＬＶＨ及ＤＩＳ的高血压病患者ＣＦＲ最低（Ｄ／ＲＰＤＶ：１．６０±０．２７比２．１９±０．３５，２．２９±０．４３；Ｄ／ＲＰＳＶ：１．５４±０．２９比２．１８±０．３７，２．１９±０．４５，Ｐ＜０．０５），而高血压ＬＶＨ但胰岛素敏感性正常病人ＣＦＲ与高血压合并ＤＩＳ的非ＬＶＨ患者之间差异无显著性（Ｐ＞０．０５）。结果表明：ＬＶＨ和Ｄ?

Aim:Tostudytherelationshipbetweencoronarybloodflowreserve(CFR)andde-creasedinsulinsensitivity(DIS)inpatientswithhypertensiveleftventricularhypertrophy(LVH).Methods:CFRofnormalsubjects(NS,n=20),hypertensivenon-LVHpatients(HT+non-LVH,n=32)andhypertensivepatientswithLVH(HT+LVH,n=33)werestudiedwithtransesophagealDopplerechocardiography(TEE)technique(Iliceto′smethod).Theratioofdipyridamoletorestpeakdiastolicvelocity(D/RPDV)anddipyridamoletorestpeaksystolicvelocity(D/RPSV)wereconsideredasindicesofCFR.Insulinsensitivity(IS)wasquantifiedusingeuglycemicinsulinclamptechnique(EICT).Results:Itwasfoundthat(1)D/RPDVandD/RPSVweresignificantlylesinHT+LVHgroupversusgroupNSandgroupHT+non-LVH(1.74±0.37,1.67±0.41versus2.66±0.58,2.30±0.37and2.56±0.46,2.45±0.48respectively,P<0.01),withnodiferenceofD/RPDVandD/RPSVbetweengroupNSandHT+non-LVH(2.66±0.58,2.30±0.37versus2.56±0.46,2.45±0.48,P>0.05).(2)TheincidenceofimpairedCFRwashigherinhypertensivepa-tientswithDIS(77.8%)comparedtohypertensivepatientswithnormalinsulinsensitivity(NIS)(20.7%).(3)ThemostsignificantreductioninCFRwasfoundinpatientswithhypertensiveLVHaccompaniedwithDIS(D/RPDV:1.60±0.27versus2.19±0.35,2.29±0.43;D/RPSV:1.54±0.29versus2.18±0.37,2.19±0.45,respectively,P<0.05),whithnosignificantdiferencesofimpairedCFRbetwenpatientswithhypertensiveLVHwithNISandhypertensivepatientswithnon-LVHandDIS(P>0.05).Conclusion:TheabovedatashowedthatLVHandDISarethetwoaddi-tiveriskfactorsforimpairedCFRinpatientswithhypertension.