原发性高血压患者脉压指数、胰岛素抵抗与左心室肥厚的关系

Relationship of Pulse Pressure Index and Insulin Resistance to Left Ventricular Hypertrophy in Patients with Essential Hypertension

目的探讨原发性高血压患者脉压指数(PPI)、胰岛素抵抗与左心室肥厚(LVH)的关系。方法对258例原发性高血压患者测定空腹血糖(FSG)、空腹血胰岛素浓度(INS)及血压水平,计算胰岛素敏感指数(ISI)、脉压指数(PPI)。采用超声心动图测量舒张末期左心室内径、室间隔厚度、左心室后壁厚度,计算左心室重量指数(LVMI)。结果LVH组收缩压(SBP)、PPI、INS、年龄、高血压病程高于非LVH组,舒张压(DBP)、ISI低于非LVH组(均P<0.05)。高PPI组LVMI、INS高于低PPI组,ISI低于低PPI组(均P<0.05)。高胰岛素组LVMI高于正常胰岛素组,ISI低于正常胰岛素组(均P<0.05)。单因素相关分析示LVMI与PP、PPI、INS、年龄呈正相关,与ISI呈负相关(均P<0.05);多元逐步回归分析示PPI的标准化回归系数最大。结论原发性高血压患者的PPI、胰岛素抵抗与LVH密切相关,PPI、ISI可作为LVH的预测指标。

Objective To investigate the relationship of pulse pressure index （PPI）, insulin resistance and left ventricular hypertrophy（LVH） in patients with essential hypertension. Methods The levels of fasting blood glucose （FSG）, fasting insulin （INS）and blood pressure were determined to calculate insulin sensitivity index ventricular end-diastolic diameter, （ISI）and PPI in 258 patients interventricular septal thickness with essential hypertension. Left and left ventricular posterior wall thickness were measured by echocardiography and left ventricular mass index （LVMI）was calculated. Results Compared with non-LVH patients, systolic blood pressure （SBP）, PPI, INS, age and course of hypertension significantly increased, but diastolic blood pressure （DBP） and ISI obviously decreased in LVH patients （P〈0.05）. The high PPI group LVMI, INS were higher than those of low PPI group, and ISI was lower than PPI group（all P〈0.O5）.High insulin group LVMI was significantly higher than that of normal insulin group, ISI was lower than normal insulin group （all P〈0.05）. Univariate analysis showed that LVMI was positively correlated with PP, PPI, INS and age, but negatively correlated with ISI（all P〈0.05）. Stepwise multiple regression analysis showed that PPI had maximal regression coefficient. Conclusion The PPI and insulin resistance are closely related to and LVH in patients with essentialhypertension. Therefore, PPI and ISI can be used to predict LVH.