高胰岛素血症与原发性高血压内皮细胞功能改变

Influence of hyperinsulinemism on the changes of endothelial function in essential hypertensive patients

目的 探讨高胰岛素血症对原发性高血压（ＥＨ） 内皮细胞功能的影响，了解胰岛素（ＩＮＳ） 与ＥＨ 患者血浆内皮素（ＥＴ） 和一氧化氮（ＮＯ）水平的关系。方法 应用放免法和化学法检测８２ 位ＥＨ患者血浆ＩＮＳ、ＥＴ和ＮＯ水平，依据患者血浆ＩＮＳ水平将ＥＨ患者分为高ＩＮＳ血症（ＨＩ）组及非高ＩＮＳ血症（ＮＨＩ）组，分析２ 组间数据。结果 ＥＨ患者血浆ＩＮＳ、ＥＴ水平及ＥＴ／ＮＯ升高，ＮＯ水平下降。血浆ＮＯ水平及ＥＴ／ＮＯ比值与ＩＮＳ水平相关（ｒ＝ ０．３３和－ ０．２５，Ｐ＜０．０１ 和０．０５） 。亚组中，ＨＩ组ＩＮＳ、ＮＯ水平高于ＮＨＩ组。血浆ＮＯ水平与ＩＮＳ中度相关（ｒ＝０．５１，Ｐ＜ ０．０１）。在ＮＨＩ组，则关系不明显。结论 ＥＨ 患者内皮细胞功能障碍，ＥＴ／ＮＯ 比值失衡，高胰岛素血症对此产生了一定影响。仅在伴有高胰岛素血症的ＥＨ 患者，其血浆ＮＯ水平才与ＩＮＳ呈正相关。

Objective To investigate the influence of hyperinsulinemia(HI) on endothelial function in patients with essential hypertension (EH), and the relationship of the plasma level of insulin (INS) to those of endothelin(ET) and nitric oxide (NO). Methods 82 patients with EH were studied by measuring plasma levels of INS, ET and NO using radioimmunoassay and chemical methods. According to the level of plasma INS,the EH patients were divided into 2 subgroups: hyperinsulinemia group (HI) and non-hyperinsulinemia group (NHI). Results The levels of plasma INS and ET and the ratio of ET/NO were increased in EH patients, compared with the control (16.53±10.46 vs 9.39±2.52, 49.32±15.97 vs 39.37±8.39 , 6.36±4.43 vs 2.55± 0.60 , respectively P <0.01).The plasma level of NO was decreased in the patients (9.63± 3.49 vs 15.68±2.50, P <0.01), The plasma NO and ET/NO ratio were correlated to plasma INS (r=0.33 and -0.25, P<0.01 and 0.05 respectively).The levels of plasma INS and NO were higher in HI patients than in NHI patients (27.03±11.51 vs 11.06±3.61, P <0.01; 10.86±2.61 vs 8.92±3.81, P <0.05, respectively).The level of plasma NO was moderately correlated to plasma INS ( r =0.51, P <0.01) in HI patients, but no such correlation was in NHI patients. Conclusion Endothelial cell dysfunction and imbalance of ET/NO present in EH are influenced by HI to a degree. The level of plasma NO is positively correlative to plasma INS only in patients of EH with HI.