2型糖尿病胰岛素抵抗与血压的关系

The relationship between insulin resistance and blood pressure in type 2 diabetes

目的 探讨2型糖尿病（DM）胰岛素抵抗（IR）在高血压发生机制中的作用。方法 检测了60例2型DM患者及40例正常对照者的空腹血糖（FBG）、空腹胰岛素（FINS）、HbA1C、血脂、红细胞膜Na+-K+-ATP酶与Mg2+-ATP酶活性及血压等，并将DM组分为A组（IS＞0.6）及B组（IS≤0.6）。结果 2型DM患者FBG、HbA1C 、FINS、TG、TC及B组血压均显著增高，胰岛素敏感性指数（ISI）、HDLc、Na+-K+-ATP酶及Mg2+-ATP酶活性显著降低，且后两者均与ISI呈显著正相关，与FINS、SBP呈显著负相关，Na+-K+-ATP酶并与DBP呈显著负相关。与DM A组比较，DM B组以上变化更为显著。结论 2型DM存在IR。IR是导致高胰岛素血症、Na+-K+-ATP酶、Mg2+-ATP酶及脂质代谢异常的关键因素，并且后者也是IR导致血压升高及高血压的重要途径。

：Objective To reveal the role of insulin resistance in the pathogenesis of hypertension in type 2 diabetes. Methods Fasting blood glucose (FBG), fasting insulin(FINS), glycosylated hemoglobin (HbA1c), triglyceride (TG), cholesterol (TC), high density lipoprotein cholesterol (HDLc), the activities of Na+-K+-ATPase and Mg2+-ATPase of erythrocyte membrane, systolic pressure (SBP) and diastolic pressure (DBP) were measured in 60 type 2 diabetics and 40 normal subjects. The diabetics were divided into two groups, that is DM A (Insulin Sensitivity, IS＞0.6) and DM B (IS≤0.6). Results The levels of FBG, HbA1c, FINS, TG, TC and blood pressure of DM B significantly increased while the levels of insulin sensitivity index (ISI), HDLc, the activities of Na+-K+-ATPase and Mg2+-ATPase of erythrocyte membrane significantly decreased in diabetics as compared with normal subjects. And the changes of the activity of Na+-K+-ATPase and Mg2+-ATPase were positively correlated with ISI, inversely correlated with FINS, SBP. In addition the activity of Na+-K+-ATPase was inversely correlated with DBP. The above abnormal changes were more marked in DM B than in DM A. Conclution Insulin resistance in type 2 diabetics may have a marked effect on the activity of Na+-K+-ATPase and Mg2+-ATPase of erythrocyte membrane and be responsible for the abnormalities of blood lipid, which may be involved in the pathogenesis of diabetic hypertension .