初诊高血压患者血尿酸与肥胖和胰岛素抵抗的相关性研究

Correlation between serum uric acid and obesity, insulin resistance in newly diagnosed hypertension

目的探讨初诊未治疗原发性高血压患者血尿酸水平和肥胖、胰岛素抵抗的相关性。方法选取2012年11月至2013年7月第三军医大学西南医院体检中心高血压患者260例,根据体质指数(BMI)分为肥胖高血压组(OHT)(132例)和非肥胖高血压组(HT)(128例),64例健康体检者作为对照组(NC),观察3组尿酸水平,比较高尿酸血症(HUA)患病率。探讨人体测量参数、血压、代谢指标、胰岛素抵抗指数(HOMA-IR)与尿酸的相关性。结果 OHT组HUA患病率明显高于HT组(43.94%vs.13.27%,P<0.05)。OHT组和HT组尿酸、HOMA-IR明显高于NC组,OHT组尿酸、HOMA-IR明显高于HT组(P<0.05)。Pearson相关分析提示尿酸与体重、BMI、腰围、腰臀比、收缩压、舒张压、甘油三酯、LDL-C、FINS、HOMA-IR正相关,与HDL-C负相关(P<0.05)。多元回归显示,性别、BMI、舒张压、甘油三酯、HDL-C是尿酸的独立影响因素。结论高血压患者体内出现明显高尿酸血症并伴胰岛素抵抗,随体质指数增加,血尿酸水平增高,胰岛素抵抗进一步加重。推测血尿酸可能通过促进胰岛素抵抗参与肥胖高血压的发生发展。

Objective To investigate the correlation between serum uric acid and insulin resistance, obesity in untreated essential hypertension. Methods From November 2012 to July 2013, 260 hypertension patients were enrolled in Southwest Hospital medical examination center of Third Military Medical University. These patients were divided into obese hypertensive group（OHT） （132 cases） and non-obese hypertensive group （HT）（128 cases） according to body mass index （BMI）, in addition 64 healthy individuals as control group（NC）. Observe serum uric acid levels of 3 groups, compare the hyperuricemia （HUA） prevalence. The correlation between anthropometric parameters, blood pressure, metabolic markers, insulin resistance index （HOMA-IR） and serum UA was analyzed. Results HUA prevalence of OHT was significantly higher than HT （43.94% vs. 13.27%, P〈0.05）. Compare to NC group, serum UA and HOMA-IR were significantly higher in OHT and HT group （P〈 0.05）. Serum UA and HOMA-IR of OHT was significantly higher than the HT（P〈0.05）. Pearson correlation show that Serum UA and body weight, BMI, waist circumference, waist-hip ratio, SBP, DBP, TG, LDL-C, FINS, HOMA-IR was positively correlated, and negatively correlated with HDL-C（P〈0.05）. Multiple regression analysis showed that sex, BMI, DBP, TG, I-IDL-C were the independent influence factors of serum UA. Conclusion There was significant hypernricemia associated with insulin resistance in hypertension patients. With the increase in body mass index, serum uric acid increased, insulin resistance further. Speculated that uric acid may though promote insulin resistance participate the occurrence and development of obesity hypertension.