Valensi P, Dabire H, Brahimi M, Paries J, Platon P, Attali J R
Service d'endocrinologie-diabétologie-nutrition, hôpital Jean-Verdier, Bondy.
Arch Mal Coeur Vaiss. 2001 Aug;94(8):941-3.
Several studies have well demonstrated that obesity is associated with changes in cardiovascular vagosympathetic activity. The aim of the present work was to evaluate this activity in normotensive and in mildly hypertensive obese patients, and to correlate this activity with clinical and biological indexes of insulin resistance. Heart rate (HR) and systolic blood pressure (sBP) were examined by spectral analysis in 70 normotensive obese patients (group 1), 32 mildly hypertensive obese patients (group 2), and 21 controls. The high frequency peak of HR variations at a controlled breathing rate (vagal activity) was significantly reduced in both groups (p < 0.001). The mid frequency peak of sBP in the standing position (sympathetic activity) was similar in both groups and in the control group. In groups 1 and 2, the high frequency peak correlated negatively with age (p = 0.005 and 0.034 respectively). In group 1, the mid frequency peak correlated positively with fat mass, fasting plasma insulin and triglyceride levels, and insulin resistance index (p < or = 0.03). In group 2, the mid frequency peak correlated positively with fasting insulin and insulin resistance index (p = 0.006 and 0.007 respectively). This study shows that, in obese patients: 1. cardiac vagal activity is reduced in normotensive and mildly hypertensive subjects; 2. vascular sympathetic activity is unchanged in means but may be increased as a consequence of adiposity, hyperinsulinemia and insulin resistance, and this increase is likely to be involved in the increase of blood pressure.
多项研究已充分证明，肥胖与心血管迷走交感神经活动的变化有关。本研究的目的是评估血压正常和轻度高血压肥胖患者的这种活动，并将该活动与胰岛素抵抗的临床和生物学指标相关联。通过频谱分析检查了70名血压正常的肥胖患者（第1组）、32名轻度高血压肥胖患者（第2组）和21名对照组的心率（HR）和收缩压（sBP）。两组在控制呼吸频率时HR变化的高频峰值（迷走神经活动）均显著降低（p < 0.001）。两组和对照组站立位时sBP的中频峰值相似。在第1组和第2组中，高频峰值与年龄呈负相关（分别为p = 0.005和0.034）。在第1组中，中频峰值与脂肪量、空腹血浆胰岛素和甘油三酯水平以及胰岛素抵抗指数呈正相关（p ≤ 0.03）。在第2组中，中频峰值与空腹胰岛素和胰岛素抵抗指数呈正相关（分别为p = 0.006和0.007）。本研究表明，在肥胖患者中：1. 血压正常和轻度高血压患者的心脏迷走神经活动降低；2. 血管交感神经活动的平均值未改变，但可能因肥胖、高胰岛素血症和胰岛素抵抗而增加，这种增加可能与血压升高有关。
