高血压病胰岛素抵抗的相关因素及与镁代谢的关系

The correlating factors of insulin resistance in essential hypertension and its relation to magnesium metabolism

目的 研究高血压病 (EH)胰岛素抵抗的相关因素。方法 观察EH患者和正常对照者的血清胰岛素样生长因子 1(IGF 1)、血清生长激素、红细胞膜胰岛素受体活性、红细胞内ATP含量和2 4h尿钙、镁和红细胞钙、镁量 ,采用多因素相关和多元逐步回归的方法分析。结果 (1)EH组胰岛素敏感指数、血清生长激素、红细胞胰岛素低亲合受体结合位数、2 4h尿镁和红细胞镁含量降低 ,血IGF Ⅰ、红细胞胰岛素受体解离常数KD2 、红细胞钙升高 ,差异有显著性。 (2 )EH组中 ,胰岛素敏感指数与平均动脉压血压、高血压家族史、体重指数、血清IGF Ⅰ、腰臀围比呈负相关 ,与红细胞胰岛素低亲合受体结合位数、红细胞镁含量呈正相关 ,有统计学意义。 (3)EH组中 ,红细胞膜胰岛素低亲和受体水平与红细胞内镁含量、2 4h尿钙、尿镁排泄量正相关。 (4)红细胞内镁含量与 2 4h尿镁、尿钙排泄量正相关。结论 EH胰岛素抵抗的关键环节可能在其受体水平 ;受体的功能下调与镁代谢障碍有关。血IGF 1可能是胰岛素抵抗的独立相关因素。细胞内镁水平降低是EH与胰岛素抵抗联系的中心环节。

Objective To investigate the correlating factors of insulin resistance (IR) in essential hypertension (EH). Method Serum growth hormone (GH), insulin like growth factor I (IGF I), erythrocyte insulin receptor (EIR), the concentrations of erythrocyte magnesium, calcium and ATP, and 24 hour urinary excretion of magnesium, calcium were analyzed. 30 normotensive subjects and 47 patients with essential hypertension were evaluated in the study. IR was assessed by means of insulin sensitivity index (ISI=1/fast glucose multiply fast plasma insulin). The correlation analysis and the stepwise multiple linear regression analysis were used to clarify correlate factors of IR. Results (1) ISI, GH, erythrocyte magnesium, urinary excretion of magnesium, low insulin affinity binding site of EIR (RT2) were significantly lower, however, IGF 1, insulin affinity binding site of KD 2, concentrations of erythrocyte calcium were significantly higher in the EH patients than those in the controls. (2) In group of EH, ISI were negatively correlated with mean arterial blood pressure, body mass index, waist hip ratio, familial history of EH and GH( r =-0.614, P <0.001; r =-0.374, P <0.01; r =-0.386, P <0.01; r =-0.472, P <0.01; r =-0.298, P <0.05), but ISI were positively correlated to RT2, erythrocyte magnesium concentrations and IGF 1( r =0.301, P <0.01; r =0.275, P <0.05; r = 0.298, P <0.05). (3) RT2 was positively correlated to erythrocyte magnesium levels and urinary excretion of calcium and magnesium( r =0.279, P <0.05; r =0.391, P <0.01; r =0.281, P <0.05). (4) Erythrocyte magnesium concentrations was positively correlated to urinary excretion of magnesium and calcium ( r =0.445, P <0.01; r =0.357, P <0.01). Conclusion (1) Down regulation insulin receptor might play an important role in pathogenesis of IR and might correlate to magnesium metabolism. (2) Abnormality in serum IGF I might be a independent risk factor in IR. (3) Abnormality magnesium metabolism might be a key linkage between IR and essential hypertension.