高血压病患者的真胰岛素、胰岛素原水平及其与血压的关系

Association of serum proinsulin and true insulin levels with hypertension

目的 探讨高血压病患者的真胰岛素 (TI)、胰岛素原 (PI)水平及其与血压的关系。方法 测定非糖尿病的 6 6例高血压病患者及 73例血压正常者的收缩压 (SBP)、舒张压 (DBP)、血脂及口服葡萄糖耐量试验 (OGTT)各点的血糖、血清TI和PI水平。TI及PI测定采用特异的单克隆抗体放大酶联免疫分析法 (BA ELISA)。结果 高血压病组在调整年龄、体重指数 (BMI)和腰臀比 (WHR)后 ,其糖负荷后 2h的PI及PI/TI水平显著高于对照组 (P <0 .0 5 ) ,而两组间TI差异无统计学意义。单相关分析显示SBP与空腹PI、2hPI及 2hPI/TI显著相关 ,而DBP仅与 2hPI/TI显著相关 (P <0 .0 5 ) ;仅在非肥胖组发现SBP与 2hTI呈正相关 (P <0 .0 5 )。多因素回归分析显示 2hPI独立于年龄、BMI、血糖和血脂等影响血压的混杂因素与SBP及高血压显著相关。结论 本人群中高血压病患者存在糖负荷后高PI血症 ,血清PI而非TI水平与高血压显著正相关。

Objective To explore the relationship of serum proinsulin (PI) and true insulin (TI) concentrations to blood pressure (BP) in hypertensives. Methods Serum levels of PI and TI in 66 nondiabetic subjects with essential hypertension (EH, systolic/diastolic BP ≥140/90 mm Hg) and 73 normotensives (NT) during 2 h 75 g oral glucose tolerance test were measured by specific monoclonal antibody based amplified ELISAs, which had no cross reaction with each other. Systolic/diastolic BP, blood glucose (BG) and serum lipids were also analyzed. Results After adjusting for age, body mass index (BMI) and waist to hip ratio (WHR), the 2 h PI and PI/TI ratio were significantly higher in EH group than in NT group [(41.7±2.5) pmol/L vs. (26.9±2.9) pmol/L and 0.305±0.026 vs. 0.205±0.035, respectively, P <0.05], but TI levels between the two groups had no statistic difference. Correlation analysis showed that systolic BP (SBP) significantly associated with fasting and 2 h PI as well as 2 h PI/TI ratio, while diastolic BP merely correlated with 2 h PI/TI ratio. The correlation of TI with SBP was only found in non obese subjects. Multivariate regression analysis demonstrated that 2 h PI remained significantly associated with hypertension and SBP after adjustment for potentially confounding factors.Conclusion Post glucose hyperproinsulinemia exists in EH subjects of the study group and serum PI, but not TI, is positively associated with hypertension.