摘要
目的 探讨高血压病 (EH)患者胰岛素敏感性与其他代谢异常的关系。方法 用正常血糖胰岛素钳夹技术测定 2 6例正常人 ,84例EH患者的葡萄糖代谢率 (M) ,用盐负荷升压及减钠降压试验测定盐敏感性。以M值作为胰岛素敏感性指标 ;以盐负荷后舒张压升高≥ 10mmHg(1mmHg =0 .133kPa)者为升压敏感 ,以口服速尿后舒张压下降≥ 10mmHg者为降压敏感 ,两者均判定为盐敏感。结果 (1)EH患者M值比正常人明显降低 [(7 13± 1 87)∶(9 13± 0 84)mg·kg-1·min-1,P <0 0 1],84例EH患者有 47例 (5 5 9% )存在胰岛素敏感性降低。 (2 ) 5 0例 (5 9 5 % )的EH患者存在盐敏感 ,有升压敏感、降压敏感和升压、降压均敏感三种类型 ,分别为 9/84(10 7% )、18/84(2 1 4% )和 2 3/84(2 7 4% ) ,5 0例盐敏感EH患者中有 2 0例 (4 0 % )存在相对性低减型肾排钠反应 [(4 8 3± 5 2 )∶(5 9 4±4 6 )mmol,P <0 0 1]。 (3)按M值把 84例EH患者分为二组 :EH合并胰岛素敏感性降低 (EH +DIS)4 7例 ,胰岛素敏感性正常的EH患者 (EH +NIS) 37例 ,EH +DIS组中盐敏感发生率、血脂、血尿酸及收缩压均比EH +NIS高 [收缩压 :(16 4± 2 0 )∶(15 2± 17)mmHg ,P <0 0 1;血清胆固醇 :(6 34± 1 0 3)∶(5 38± 0 86 )mmol/L ,P <0 0 1;
Objective To investigate the relationship between decreased insulin sensitivity (DIS) and salt sensitivity (SS), plasm lipid, serum uric acid (Ur) in hypertensive patients (EH). Methods Glucose metabolism rate (M) measured by euglycemic insulin clamp technique (EICT) in 26 normal subjects (NS) and 84 EH was taken as an index of insulin sensitivity. An increase of DBP≥10 mm Hg to rapid intravenous infusion of 1 000 ml normal saline load or a decrease of DBP≥10 mm Hg to rapid intravenoud infusion of 1 000 ml normal saline load or a decrease of DBP≥10 mm Hg to 40 mg oral dose of lasix within 2 hours was regarded as the standard of the SS. Results M value in EH was lower than that in NS(7 13±1 87 vs 9 13±0 84 mg·kg -1 ·min -1 , P< 0 01), and the incidence of DIS in EH was 55 9%. 59 5% of the EH were sensitive to the salt loading and (or) depletion of sodium (Na) by lasix. These patients could be classified into 3 groups who were sensitive to increase blood pressure (10 7%), decreased blood pressure (21 4%) and both (21 4%) respectively. In the 50 SS hypertensive patients, 20 expressed as decreased type of renal sodium excretion after saline loading (48 3±5 2 vs 59 4±4 6 mmol, P< 0 01). 84 EH were categorized into 2 groups according to M value: EH with DIS ( n =47) and EH with NIS ( n =37). Blood TC, TG, and Ur, SBP and incidence of SS in EH with DIS were significantly higher than those in EH with NIS (SBP: 164±20 vs 152±17 mm Hg, P< 0 01,TC: 6 34±1 03 vs 5 38±0 86 mmol/L, P< 0 01, TG: 2 47±0 81 vs 2 13±0 72 mmol/L, P< 0 01, serum Ur: 458 9±96 7 vs 403 7±94 9 μmmol/L, P< 0 01, the incidence of SS:80 9% vs 32 4%, P< 0 01), and no difference was found between EH with NIS and NS ( P> 0 05). Conclusion The data suggest that DIS may aggravate abnormality of salt, plasm lipid and serum Ur metabolism in patients with hypertension.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2000年第3期170-172,共3页
Chinese Journal of Cardiology
基金
福建省自然科学基金资助!(C94040)
