胰岛素拮抗在尿毒症高血压发生中的作用

The effect of insulin resistance on the development of hypertension in uremia

目的 研究胰岛素拮抗在尿毒症高血压发生中的作用。方法 采用口服葡萄糖耐量试验方法检测29例伴高血压(CRF-H)和21例无高血压(CRF-NH)尿毒症患者空腹及糖负荷后各时点血糖及胰岛素水平,计算其胰岛素敏感指数(ISI)、机体糖利用率(M)、糖及胰岛素反应曲线下面积(AUCG、AUCINS),同时测定其血浆肾素(PRA)、血管紧张素Ⅱ(AT Ⅱ)水平,并与12例正常人相比较,分析上述诸变量与尿毒症高血压的关系。结果 (1)尿毒症组较正常组糖负荷后血糖、胰岛素水平及AUCG、AUCINS显著增高,ISI、M显著低下;与CRF-NH组相比,CRF-H组糖负荷后30＇、60＇、120＇血糖水平及AUCG、糖负荷后120＇胰岛素水平及AUCINS显著增高,ISI、M显著低下,胰岛素拮抗和糖耐量异常发生率显著增加;(2)胰岛素拮抗组动脉血压值和高血压发生率显著高于非胰岛素拮抗组;动脉血压与AUCG、AUCINS呈显著正相关,与ISI、M呈显著负相关;(3)PRA、ATⅡ水平在二组尿毒症患者间无差异;(4)多因素相关分析显示AUCG、AUCINS是独立于年龄、性别、肥胖、肾衰程度、血浆肾素血管紧张素活性的影响尿毒症动脉血压的主要因素。结论 胰岛素拮抗、高胰岛素血症、糖耐量异常或高血糖可能是尿毒症高血压的重要发生机制。

Objective To study the effects of insulin resistance on the occurance of hypertension in uremia. Methods With use of the oral glucose tolerance test (OGTT) and the insulin release test (IRT) , insulin glycoregulatory activity, including insulin sensitivity index (ISI) , glucose uptake rate (M) and the total areas under the glucose and insulin curves during OGTTs (AUCG, AUCINS) were investigated in 29 hypertensive (CRF-H) and 21 normotensive (CRF-NH) urernic patients and 12 healthy controls (C), and their plasma renin activity (PRA), angiotensin Ⅱ (AT Ⅱ) levels were investigated too. Results (1) Uremic patients had significantly higher blood glucose and serum insulin levels after glucose load, much higher AUCG and AUCINS values and significantly lower ISI and M values than the controls, compared with the CRF-NH patients, CRF-H patients had significantly higher blood glucose levels at 30', 60', 120', and higher serum insulin levels at 120' during OGTTS, significantly higher AUCG and AUCINS values, significantly lower ISI and M values and significantly increased incidences of insulin resistance and glucose intolerance; (2) Insulin resistant patients had more frequency and severe hypertension than the non-insulin resistant ones; simple regression showed that arterial blood pressure (SBP, DBF, MBP) had significant negative correlation with ISI and M, significant positive correlation with AUCG and AUCINS; (3) The levels of PRA, ATⅡbetween two CRT groups were not different; (4) Multiple linear regression showed that AUCG and AUCINS had significant positive correlation with MBP independent of age、 sex、 obesity、 the degree of real failure and plasma renin-angiotensin activity. Conclusion Insulin resistance 、 hyperinsulinemia and glucose intolerance or hyperglycemia may be one of the important mechanisms of uremic hypertension.