胰岛素抵抗——遗传和环境因素致高血压的共同途径?

Is insulin resistance a common pathway for hereditary and environmental factors-induced hypertension?

目的 探讨胰岛素抵抗是否是遗传和环境因素致高血压的共同途径。方法 大庆地区具有血缘关系的三代内直系亲属 2 86核心家庭成员 858人 ,年龄 1 8～ 74岁。测血压、空腹血糖 (FPG)、胰岛素 (FINS)、胆固醇、甘油三酯、高密度脂蛋白胆固醇 (HDL C)、纤维蛋白原。计算胰岛素敏感性(ISI) =1 / (FPG×FINS) ,胰岛素抵抗 (IR) =(FPG×FINS) / 2 2 .5。以多因素回归分析探讨遗传和环境因素对血压水平的贡献。结果 原发性高血压组无论其有无阳性高血压家族史 ,胰岛素敏感性都较差。多因素逐步回归分析结果显示 ,胰岛素敏感性是高血压伴高血压家族史者、高血压不伴高血压家族史者及正常血压不伴高血压家族史 (且其配偶血压也正常 )者血压升高最重要的因素 ,能解释平均血压 (MBP)变化的 1 7% ;而空腹血糖、总胆固醇与HDL C 3项只能解释MBP变化的 9%。在分析自变量中加入高血压家族史一项时 ,则阳性高血压家族史成了血压升高最重要的因素 ,仅此一项就可解释MBP变化的 30 % ,而胰岛素敏感性对血压水平的贡献大幅度削弱 ,仅能解释MBP的 7%。对配偶组的分析显示同样趋势。结论 胰岛素抵抗是遗传及环境因素致高血压重要的共同途径 。

Objective To investigate whether insulin resistance is the common route for hereditary and environmental factors to cause hypertension. Methods 93 hypertensives with family history of hypertension, 94 hypertensives without family history of hypertension and 99 normal tensives without family history of hypertension as well as their spouse, and one child in each family were enrolled in the present study. Insulin sensitivity was calculated from fasting plasma glucose (FPG) and insulin (FINS) with the formula insulin sensitivity index (ISI)=1/(FPG×FINS) and insulin resistance index (Homa IR)=(FPG×FINS)/22.5. The contribution of insulin resistance to blood pressure elevation was investigated by multivariate regression analysis. Results Subjects with essential hypertension, regardless of the presence or absence of family history of hypertension, were more insulin resistant. Multivariate regression analysis demonstrated that insulin resistance contributed to 17% of mean blood pressure (MBP) elevation, whereas taken FPG+ total cholesterol(TC)+high desity lipoprotein(HDL) together it explained only 9% of MBP changes in the indicator group. When family history of hypertension was included as a independent variable in the analysis, it became the most important factor instead of insulin resistance in the model and contributed to 30% of the changes of MBP , while contribution of insulin resistance was significantly reduced as to explain only 7% of the changes of MBP. Conclusions Insulin resistance is a common route for hereditary and environmental factors to induce hypertension. It is suggested that improving insulin sensitivity may play an important role in the management of essential hypertension.