高血压病患者胰岛素抵抗与其他代谢异常的关系

Relationship between insulin resistance and other metabolic disorders in hypertensive patients

目的探讨高血压病患者胰岛素敏感性与其他代谢异常的关系。方法用正常血糖胰岛素钳夹技术测定26例健康者和84例高血压病患者的葡萄糖代谢率,用盐负荷升压及减钠降压试验测定盐敏感性。结果高血压病患者葡萄糖代谢率比正常人明显降低(P<0.01),84例高血压病患者中有47例(55.9%)存在胰岛素敏感性降低,50例(59.5%)存在盐敏感。按葡萄糖代谢率数值把84例高血压病患者分为两组:高血压病合并胰岛素敏感性降低组(降低组)47例,胰岛素敏感性正常组(正常组)37例。经方差分析,纠正体重指数后,降低组的各项代谢指标仍比正常组高,盐敏感发生率分别为58.1%,21.7%(P<0.01)。结论胰岛素敏感性降低加重了高血压病患者盐、血脂及血尿酸等的代谢紊乱,胰岛素抵抗可能是其他各项代谢异常的根源。

Objective To explore the relationship between insulin resistance and other metabolic disorders in patients with essential hypertension （EH）. Methods Glucose metabolism rate （GMR） was measured by euglycemic insulin clamp technique, and salt sensitivity was tested by increase in blood pressure after salt load and its decreases after depletion of sodium in 26 healthy subjects and 84 patients with EH. Results GMR lowered significantly in patients with EH than that in healthy subjects, P 〈 0.01. Declined insulin sensitivity was found in 47 （55.9%） and salt sensitivity in 50 （59.5%） of 84 patients with EH. All metabolic indexes were still higher in patients with EH with declined insulin sensitivity than in those with normal insulin sensitivity by analysis of variance adjusted for their body mass index. Salt sensitivity rates were 58. 1% and 21.7% in patients with EH with declined insulin sensitivity and those with normal insulin sensitivity, respectively, P 〈 0.01. Conclusions Declined insulin sensitivity aggravated metabolic disturbance of salt, lipid and uric acid in patients with EH, which may be caused by insulin resistance.