高血压病患者微量白蛋白尿与血脂异常和胰岛素抵抗的关系及其临床意义

The relationship between microalbuminuria and dyslipidosis,insulin resistance in essential hypertensive patients and its clinical significance

通过测定33例Ⅰ、Ⅱ期高血压病（EH）有微量白蛋白尿（MAU）和无微量白蛋白尿（NMAU）患者及15例正常人的空腹及糖负荷后血糖及血胰岛素浓度、空腹血脂及载脂蛋白，发现：①EH患者空腹及糖负荷后2h血胰岛素明显高于正常人（P＜0．05）；②伴MAU的EH患者糖负荷后2h血胰岛素浓度明显高于无MAU者（P＜0．02）；③伴MAU者高密度脂蛋白胆固醇降低，甘油三酯升高，与正常人比较差异有显著性（P＜0．05）。提示伴MAU的EH患者有明显的胰岛素抵抗及脂质代谢异常，此可能为伴MAU的EH患者冠心病发病率及死亡率升高的原因。

We determined serum levels of fasting insulin, 2 h insulin response to glucose,serum lipid profile, apolipoproteins A and B in 33 hypertensives [15 with microalbuminuria (MAU), 18 without MAU] and 15 normotensive control subjects. All of the patients were in Ⅰ or Ⅱ stage. The results showd: ① the hypertengive patients show higher fasting serum insulin level and 2 h insulin level response to oral glucose compared with control subjects(P＜0.0 5);② the patients with MAU had significantly greater 2h serum insulin level than those without MAU(P＜0.02);③the microalbuminuric patients displayed lower HDL-C levels and higher TG levels than normoalbuminuric patients (P＜0. 05). It suggests albuminuria has insulin resistance and abnormal lipid metabolism. These may be the important causes of higher coronary heart disease morbidity and mortality in essential hypertension.