原发性高血压患者餐后甘油三酯代谢异常与胰岛素抵抗的关系

The relationship between insulin resistance and postprandial abnormal serum triglyceride metabolism in essential hypertension

目的 研究原发性高血压患者 (EH)餐后甘油三酯代谢异常与胰岛素抵抗的关系。方法 4 4例EH患者和 2 2例健康人禁食 10～ 12h后 ,进行标准脂肪负荷试验 ,以甘油三酯 (TG) 8h曲线下面积 (TG AUC)和TG峰反应 (TGPR)作为标准脂肪负荷后TG反应水平的指标。以胰岛素敏感性指数 (ISI)及胰岛素曲线下面积 (IS AUC)作为胰岛素敏感性的判定指标。结果 (1)EH组TG AUC ,TGPR均显著高于对照组 (2 0mmol/L± 6mmol/L比 10mmol/L± 4mmol/L ,P <0 0 5 ;4 14mmol/L±3 0mmol/L比 2 0 6mmol/L± 1 32mmol/L ,P <0 0 1)。 (2 )EH组IS AUC显著高于对照组 (194mU/L±6 0mU/L比 130mU/L± 2 9mU/L ,P <0 0 5 ) ;ISI显著低于对照组 (- 4 12± 0 4 6比 - 3 76± 0 2 4 ,P <0 0 5 )。 (3)EH合并胰岛素敏感性降低者 (n =2 7)其餐后TG AUC ,TGPR显著高于EH胰岛素敏感性正常者 (n =17) (2 5mmol/L± 13mmol/L比 13mmol/L± 7mmol/L ,P <0 0 1;5 2 5mmol/L± 3 0 3mmol/L比3 16mmol/L± 1 4 6mmol/L ,P <0 0 5 ) ;而EH胰岛素敏感性正常者与正常对照组无显著性差别。结论 高血压病患者存在餐后TG代谢障碍和消除延迟 ,胰岛素抵抗影响高血压病患者餐后甘油三酯代谢 ,是餐后甘油三酯代谢异常的重要影响因素。

Objective To investigate the relationship between insulin resistance(IR) and postprandial abnormal metabolism of serum triglyceride rich lipoprotein in essential hypertension (EH) Methods In 44 patients with EH and 22 normal subjects(NS) Total cholesterol, HDL cholesterol, LDL cholesterol, apoliprotein AI and apoliprotein B in fasting serum and serum triglyceride before and 2?4?6?8 hours after a standardized fat loading were measured Triglyceride peak response (TGPR) and the area under triglyceride curve(TG AUC) over 8 hours were taken as the index of abnormal TG metablism Standardized 75g oral glocuse tolerance test was carried, the area under insulin curve(IS AUC) over 3 hours and insulin sensitivity index were taken as the index of insulin sensitivity Results TGPR and TG AUC were higher in EH than those in NS(TGRP: 4 14 mmol/L±3 0 mmol/L vs 2 06 mmol/L±1 32 mmol/L, P <0 01;TG AUC: 20 mmol/L±6 mmol/L vs 10 mmol/L±4 mmol/L, P <0 05) 65 9% of EH had postprandial abnormal serum triglyceride metabolism IS AUC was higher in EH than that in NS, and ISI was lower in EH than that in NS The incidence of IR in EH was 61% 44 EH were categorized into 2 groups according to insulin sensitivity: EH with IR( n =27) and EH with normal insulin sensitivity(NIS, n =17) TGPR and TG AUC in EH with IR were significantly higher than those in EH with NIS(TGPR: 5 25 mmol/L±3 03 mmol/L vs 3 16 mmol/L±1 46 mmol/L, P <0 05; TG AUC: 25±13 mmol/L vs 13±7 mmol/L, P <0 01) No significant difference was found between EH with NIS and NS ( P >0 05) TG AUC and TRPG was positively related to IS AUC and negatively related to ISI Conclusion Patients with EH had postprandial abnormal serum triglyceride metabolism, insulin resistance may aggravate postprandial triglyceride metabolism in EH