低脂联素血症——高血压心肌肥厚独立的危险因素

Hypoadiponectinemia——independent risk factor of hypertensive cardiac hypertrophy

目的探讨脂联素及部分高血压危险因素与高血压心肌肥厚的关系,进一步明确低脂联素血症是否为高血压心肌肥厚的独立危险因素。方法①通过测量血压和心脏超声检查,把观察对象分为单纯高血压组(n=30)、高血压合并心肌肥厚组(n=19)和正常血压组(对照组,n=28)。②常规测量身高、体重,自动化生化分析仪测甘油三酯(TG)、总胆固醇(TCH)、低密度脂蛋白胆固醇(LDL)、高密度脂蛋白胆固醇(HDL)、空腹血糖(FPG),用固相酶联免疫吸附法测定空腹胰岛素(FIN),用双抗体夹心酶联免疫吸附法测定血清脂联素浓度。③计算体重指数(BMI)、胰岛素抵抗指数(HOMA-IR)、左心室质量指数(LVMI)。④对3组病例进行关于脂联素的方差分析,对所有观察对象各变量间进行相关分析。结果①与对照组比较,单纯高血压组、高血压合并心肌肥厚组血清脂联素浓度明显降低(P<0.05)。②相关分析表明:LVMI与收缩压(SBP)、舒张压(DBP)、FPG、FIN、HOMA-IR和TG呈明显的正相关,与脂联素呈明显的负相关(r=-0.431,P<0.01),与HDL、BMI、LDL和TCh相关性未达到统计学差异。FPG、FIN、HOMA-IR、LDL和TG虽与LVMI明显相关,但在控制脂联素和血压后,无明显相关性。结论①血压、脂联素、血脂、血糖、胰岛素和胰岛素抵抗与高血压心肌肥厚相关。②血脂、血糖、胰岛素和胰岛素抵抗不是高血压心肌肥厚独立的危险因素,而是通过血压、脂联素发挥作用。③高血压心肌肥厚主要与收缩压和脂联素相关,收缩压和低脂联素血症是高血压心肌肥厚独立的危险因素。

Objective To investigate the relationships between serum adiponectin concentration and hypertensive cardiac hypertrophy and that to other risk factors causing cardiac hypertrophy, so as to further demonstrate hypoadiponectinemia as an independent risk factor. Methods （1）Based on the results of BP and UCG, the subjects were divided into three groups： normotensive （control）, essential hypertensive （EH） and essential hypertensive with cardiac hypertrophy （EH ＋ LVH）.（2）Body height and body mass were measured to calculate body surface. Triglycerides （TG）, total cholesterol （TCh） , low- density lipoprotein （ LDL）, high - density lipoprotein （HDL） and fast plasma glucose （FPG） were determined with automated biochemical analyser. Fasting insulin （FIN） was examined by insolubilized enzyme linked immunosorbent assay; adiponectins, by ABC - ELISA. （3）Body mass index （ BMI）, homeostasis model assessment of insulin resistance （ HOMA - IR） and left ventricular mass index （LVMI） were calculated. （4）Tbe data were analysed by one - way ANOVA and for correlation of the variables with LVMI as the dependent variable. Results （1）The serum adiponectin concentration was lower in EH ＋ LVH group than in the normotensive control and EH groups （ P 〈 0.01 ）.（2）LVMI was found negatively correlated with adiponectin （ r = -0.43, P 〈0.01 ）, and positively correlated with BP, FPG, FIN, HOMA - IR and TG （ P 〈 0.05 ）. However, when adiponectin and BP were controlled,, there would no longer be any correlation between LVMI and FPG, FIN, HOMA - IR or TG （ P 〉 0.05 ）. Conclusions （1）Hypertensive cardiac hypertrophy is correlated with BP, adiponectin, FPG, FIN, HOMA - IR and TG. （2）FPG, FIN, HOMA - IR and TG are not independent risk factors, they exert impacts on LVMI through SBP and adiponectin level. （3）Hence SBP and adiponectin lowering are the independent risk factors of hypertensive cardiac hypertrophy.