高血压患者围术期胰岛素抵抗与胆固醇酯转运蛋白TaqIB多态性

Perioperative insulin resistance and TaqIB polymorphisms of cholesteryle ester transfer protein(CETP) in patients with essential hypertension

目的探讨术后胰岛素抵抗程度与血脂水平、胆固醇酯转运蛋白(CETP)TaqIB多态性的相关性。方法86例非糖尿病全身麻醉下择期手术患者,分原发性高血压组(H组)57例和健康对照组(C组)29例。入院后测定血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、空腹血糖(FPG)。分别在麻醉前、术后第1天测定FPG、空腹胰岛素(FINS),并计算胰岛素敏感指数(ISI)。运用PCR-RFLP技术对入选患者进行CETPTaqIB多态性分析。结果H组患者存在空腹高胰岛素血症(P<0.05),血脂特点为高TC、高TG(P<0.05)。H组较C组术后第1天ISI更低(P<0.05)。H组△ISI明显低于C组(P<0.05)。CETPB2B2基因型高血压患者△ISI低于B1等位基因携带者(P<0.05)。结论高血压患者术前存在高胰岛素血症和脂代谢紊乱,手术应激后出现更显著加重的胰岛素抵抗。术后胰岛素抵抗程度与HDL-C、CETPTaqIB多态性有关,B2B2基因型高血压患者术后胰岛素抵抗程度加重。

Objective To investigate the relation among the perioperative insulin resistance （IR）, serum lipid leavels and the TaqIB polymorphisms of choleteryle ester transfer protein（CETP） in patient with essential hypertension （EH）. Methods Fifty-seven patients with EH, without diabetes mellitus（group H） and 29 healthy control patients without EH and diabetes mellitus（group C）, scheduled for surgery under general anesthesia, were enrolled in this study. The indices of TC, TG, HDL-C, LDL-C, FPG were measured. Blood concentrations of glucose （FPG） and insulin were measured before anesthesia induction and on the first postoperative day in each group. CETP TaqIB gene was genotyped with PCR-RFLP technique. Results The patients with EH were hyperinsulinemic before anesthesia with increased total cholesterol and triglyceride levels（P〈0.05）. The insulin sensitivity index （ISI） level in group H was significantly lower than that in group C on the first operative day （P〈 0.05）. The decrease of ISI during perioperative period in group H was significantly more than that in group C（P〈0.05）. The decrease of ISI was significantly more evident in B2B2 genotype than that in B1 allele in EH patients （P 〈 0.05）. Conclusion There are hyperinsulinemic and lipid metabolic disorders in patients with EH, which may result in an increase of IR postoperatively. HDL-C levels and CETP TaqIB gene polymorphism may be associated with the degree of perioperative IR. The patients with B2B2 genotype have more severe perioperative IR.