胰岛素抵抗与高血压病患者左心室肥厚及构型改变的相关性

Relation of Insulin Resistance to Left Ventricular Hypertrophy and Geometry in Essential Hypertension

目的 初步探讨胰岛素抵抗对高血压病患者左心室重量和构型的影响。方法 97例轻、中度高血压患者行口服葡萄糖耐量试验(OGTT)加同步胰岛素释放试验(InRT),利用Cederholm公式计算胰岛素敏感性指数(ISIc),以定量评价胰岛素敏感性,并对受试者的心脏超声资料进行分析。结果 将年龄、性别、体重指数、血脂、血压等因素固定后,ISIc与心脏重量指数(LVMI)无关,而与相对室壁厚度(RWT)负相关,负荷后的血糖及胰岛素水平与RWT正相关。糖耐量正常(NGT)组与糖耐量异常(IGT)组年龄、性别、BMI均匹配,血压水平控制相当,而IGT组心室壁厚度显著大于NGT组,左心室内径无明显差别。结论 胰岛素抵抗与高血压患者左心室肥厚无关,但与左心室向心性改变密切相关。

Objective To test the association of insulin resistance and left ventricular ( LV ) hypertrophy and geometry. Methods We studied 97 nondiabetic subjects with mild to moderate essential hypertension. All subjects were investigated with oral glucose tolerance test (OGTT) , insulin release test (InRT)and echocardiography, and insulin sensitivity index (ISIc) was measured by Cederholm formula. Results After controlling other risk factors, ISIc was negatively correlated with LV relative wall thickness (RWT) , and 2 -hour postload glucose and insulin levels were positively correlated with RWT, however , none was significantly related to LV mass index. While other variables were well matched, interventricular septum thickness and posterior wall thickness were significantly higher in IGT individuals than in NGT individuals. Conclusion Insulin resistance is related to concentric changes in LV geometry, but not to LV hypertrophy in mild to moderate nondiabetic hypertensives.