高血压病并胰岛素抵抗患者单核细胞粘附功能的变化

Changes of Mononuclear Cell Adherence to Endothelium in Hypertensive and Insulin Resistant Patients

观察高血压、胰岛素抵抗对单核细胞—血管内皮粘附功能的影响 ,采用改良的胰岛素抑制试验和单核细胞—血管内皮细胞粘附试验检测 33例高血压病患者和 32例正常对照者的胰岛素敏感性和单核细胞—血管内皮粘附功能。结果发现 ,高血压病患者单核细胞对内皮的粘附性显著高于正常对照者 (P <0 .0 1) ,且高血压患者稳态血糖浓度与单核细胞粘附数显著正相关 (r=0 .6 1,P <0 .0 0 1) ,正常对照者稳态血糖浓度与单核细胞粘附数也显著正相关 (r=0 .71,P <0 .0 0 1) ,而平均动脉压只有在两组合并分析时与单核细胞粘附数存在显著正相关关系 (r=0 .4 3,P <0 .0 0 1)。经多元回归分析发现 ,稳态血糖浓度及胰岛素浓度与单核细胞粘附数有独立的相关关系。结果提示 ,高血压、胰岛素抵抗使单核细胞对血管内皮的粘附性增强 ,这可能是高血压、胰岛素抵抗等代谢异常易发生动脉粥样硬化的机制之一。

Aim To investigate the effect of hypertension and insulin resistance on mononuclear cell binding to cultured endothelium. Methods Insulin sensitivity was estimated by modified insulin suppression test and endothelial adhesiveness for mononuclear cell was assessed by functional binding assay in 33 hypertensive patients and 32 normal controls. Results Mononuclear cell binding to endothelium increased in patients with hypertension compared to normal controls (35±9 vs 28±10,P<0.01). There was a positive relationship between mononuclear cell binding and mean arterial pressure (r=0.43,P<0.001). A positive relationship also existed between steady state plasma glucose (SSPG) concentration and mononuclear cell binding in both the hypertensive (r=0.61,P<0.001)and normotensive (r=0.71,P<0.001)groups. Multiple regression analysis demonstrated an independent relationship between mononuclear cell binding and both SSPG (P<0.001) and insulin (P<0.01). Conclusions Hypertension and insulin resistance enhance mononuclear cell adherence to cultured endothelium. It may be the linkage between atherosclerosis and both hypertension and insulin resistance.