原发性高血压患者血清高分子质量脂联素水平及其影响因素

Analysis of serum high molecular weight adiponectin levels and related factors in patients with essential hypertension

目的:观察原发性高血压患者血清高分子质量(high molecular weight,HMW)脂联素水平,探讨其与血压、肥胖、糖脂代谢、胰岛素抵抗及超敏C反应蛋白(hs-CRP)的关系。方法:纳入76例研究对象,以有无原发性高血压分为对照组和高血压组(各38例)。所有研究对象均行口服75g葡萄糖耐量试验(OGTT),检测空腹血糖、餐后2 h血糖(2 h PG)、空腹胰岛素(FINS)、餐后2 h胰岛素(2 h INS)及血脂水平,并以稳态模型评估胰岛素抵抗指数(HOMA-IR)。采用化学发光法检测血清hs-CRP水平,酶免法检测HMW脂联素水平。结果:高血压组血清HMW脂联素质量浓度为0.82(0.46~1.46)ng/L,明显低于对照组[2.53(1.70~5.75)ng/L,P<0.01]。相关分析显示血清HMW脂联素与收缩压、舒张压、平均动脉压(MAP)、体质量指数(BMI)、腰臀比、三酰甘油、空腹血糖、2 h PG、HOMA-IR、hs-CRP呈负相关,与高密度脂蛋白胆固醇(HDL-C)呈显著正相关。多元逐步回归分析提示收缩压、三酰甘油是血清HMW脂联素水平的独立影响因素(P<0.05)。二分类Logistic回归分析表明,HMW脂联素是高血压的保护因素(P<0.01)。结论:原发性高血压人群血清HMW脂联素水平明显降低,且与血压、肥胖、糖脂代谢、胰岛素抵抗及hs-CRP密切相关,提示低HMW脂联素血症可能参与了原发性高血压的发生发展。

Objective:To detect serum high-molecular-weight adiponectin(HMW APN)level in hyper-tension patients and investigate the relationships between serum HMW APN level and blood pressure,obesi-ty,glucolipid metabolism,insulin resistance and highly sensitive C-reactive protein(hs-CRP).Methods:A total of 76 subjects were enrolled in the study and divided into two groups by the definition of hypertension:the hypertension group(n =38)and the normal control group(n =38).Oral glucose tolerance test(OGTT) were performed in all subjects.Fasting plasma glucose(FPG),2 h postprandial plasma glucose(2hPG), fasting insulin(FINS),2 h postprandial serum insulin(2hINS)and lipids were also detected.Insulin resist-ance was assessed by homeostasis model assessment(HOMA-IR).Hs-CRP level was determined by chemi-luminescence immunoassay and fasting serum HMW APN level was determined by ELISA.Results:The se-rum HMW APN level in hypertension group was significantly lower than that in normal control group [0.82 (0.46 -1 .46)vs 2.53(1 .70 -5.75)ng/L,P <0.01 ].Pearson correlation analysis showed that serum HMW APN level was negatively correlated with SBP,DBP,MAP,BMI,WHR,TG,FPG,2 hPG,HOMA-IR and hs-CRP(P <0.05 or P <0.01 ),and was positively correlated with HDL-C(P <0.01 ).Multiple linear regression analysis showed that SBP and TG were independently related to serum HMW adiponectin level(P <0.05).Logistic regression analysis showed that HMW adiponectin was the independent protective factor for hypertension(P <0.01 ).Conclusion:Serum HMW adiponectin level was decreased in subjects with hypertension.Serum HMW adiponectin level was closely correlated with blood pressure,obesity,glu-colipid metabolism,insulin resistance and hs-CRP.It suggests that HMW APN decline may play an impor-tant role in the pathogenesis of hypertension.