血清瘦素水平与原发性高血压的相关性研究

Role of leptin in the pathogenesis of obesity-related hypertension

目的 探讨瘦素、肥胖、胰岛素抵抗与血压的相互关系 ,评价瘦素在高血压发病中的作用。方法 5 6 0名非糖尿病的成年男性 ,测定空腹血脂、瘦素、真胰岛素 (TI)浓度以及空腹和餐后 2h血糖。胰岛素敏感性以稳态模型抵抗指数 (HOMA R)评价。结果 空腹瘦素水平与体重指数 (BMI)、腰臀比 (WHR)、TI和HOMA R、血压以及甘油三酯和胆固醇均显著相关 (均为P <0 0 1)。在调整年龄、BMI、WHR和HOMA R后 ,瘦素仍与收缩压呈正相关 (r=0 11,P <0 0 5 ) ,而且高血压者 (除外服用降压药者 )的瘦素水平也显著高于非高血压者 (几何均值 6 4 μg/L对 4 7μg/L ,P <0 0 0 1)。肥胖、胰岛素抵抗和高瘦素血症均能明显增加高血压的检出率。Logistic回归分析也显示瘦素水平的升高与高血压的发病密切相关。结论 瘦素与肥胖型高血压的发病相关。

Objective To assess the role of leptin in the pathogenesis of obesity-related hypertension and the relationship between blood pressure (BP), and body mass index (BMI), insulin resistance and leptin were examined. Methods 560 non-diabetic men,aged 35～75,selected from volunteers of health screening test during 2 000 were divided into hypertension group (n=321, BP≥140/90 mm Hg without antihypertensive medication). and normal blood pressure group (n=239). The body weight, waist hip ratio,BP, plasma glucose, serum lipids, true insulin (TI) and leptin were measured after overnight fast. Insulin sensitivity was assessed by the HOMA insulin resistance index (HOMA-R). Results Fasting leptin level showed good correlation with BMI, fasting TI, HOMA-R, BP and also triglycerides (all P<0.01). After adjustment for age, BMI and HOMA-R, serum leptin was still positively correlated to SBP (r=0.11, P<0.05), and was significantly higher in hypertensive subjects than in normotensive subjects (geometric mean 6.4 vs 4.7 μg/L, P<0.001). Logistic regression analysis demonstrated that leptin remained significantly associated with hypertension after adjustment for potentially confounding factors. Conclusion Leptin may play an important role in the pathogenesis of obesity related hypertension.