Amoah A G B, Schuster D P, Gaillard T, Osei K
Diabetes Research Laboratory, Department of Medicine and Therapeutics, University of Ghana Medical School, Post Office Box 4236, Accra, Ghana.
Diabetologia. 2003 Jul;46(7):949-55. doi: 10.1007/s00125-003-1130-8. Epub 2003 Jun 18.
AIMS/HYPOTHESIS: The objective of this study was to examine the relationships among insulin and insulin sensitivity and risk factors for cardiovascular diseases in native Ghanaians with and without hypertension.
We measured the anthropometric parameters, systolic and diastolic blood pressure, fasting serum triglycerides, cholesterol and high-density lipoprotein cholesterol and fasting and stimulated glucose, insulin and C-peptide of 200 Ghanaian subjects, who were between 25 to 74 years of age, and residing in the Accra Metropolitan area. Serum glucose, C-peptide and insulin concentrations were measured at baseline (fasting) and also 2 h after 75 gm oral glucose drink. Homeostasis model assessment was used to measure insulin resistance. Hypertension was defined as a blood pressure higher than 140/90 mmHg.
There were 53 subjects with hypertension (HBP) and 147 subjects with normal blood pressure (NBP). The mean BMI, waist circumference and waist-to-hip circumference ratio for HBP and NBP subjects were 27.4+/-0.8, 24.8+/-0.4 kg/m(2); 89.8+/-11.7, 81.1+/-0.9 cm; and 0.87+/-0.08, 0.82+/-0.08 respectively, (p<0.05). The fasting and 2-h plasma glucose concentrations in HBP and NBP subjects were 5.5+/-0.2, 7.2+/-0.3 mmol/l and 5.2+/-01, 6.8+/-0.2 mmol/l respectively (p>0.05). The corresponding fasting and 2-h insulin concentrations were 10.0+/-0.7, 8.0+/-0.4 uU/ml and 47.3+/-3.7, 37.3+/-2.5 uU/ml respectively (p<0.05). The insulin resistance index (HOMA-IR) in the HBP and the NBP groups were 2.49+/-0.2 and 1.95+/-0.13 (p<0.05). The two groups had similar fasting and stimulated C-peptide, lipids and HDL concentrations. Correlations were found between blood pressure and the concentrations of lipids, HDL, fasting and stimulated insulin and C-peptide, and between fasting insulin and HOMA-IR with lipids and HDL concentrations. On multiple regression analysis, fasting insulin and HOMA-IR did not influence blood pressure variations significantly.
CONCLUSIONS/INTERPRETATION: We found clustering of hyperinsulinaemia, insulin resistance and truncal obesity in hypertensive Ghanaian subjects but dissociation between insulin resistance, hypertension and atherogenic lipid and lipoprotein profile.
目的/假设：本研究的目的是探讨加纳本地有高血压和无高血压人群中胰岛素、胰岛素敏感性与心血管疾病危险因素之间的关系。
我们测量了200名年龄在25至74岁之间、居住在阿克拉都会区的加纳受试者的人体测量参数、收缩压和舒张压、空腹血清甘油三酯、胆固醇和高密度脂蛋白胆固醇，以及空腹和刺激后的血糖、胰岛素和C肽。在基线（空腹）以及口服75克葡萄糖饮料后2小时测量血清葡萄糖、C肽和胰岛素浓度。采用稳态模型评估来测量胰岛素抵抗。高血压定义为血压高于140/90 mmHg。
有53名高血压（HBP）受试者和147名血压正常（NBP）受试者。HBP和NBP受试者的平均体重指数、腰围和腰臀比分别为27.4±0.8、24.8±0.4 kg/m²；89.8±11.7、81.1±0.9 cm；以及0.87±0.08、0.82±0.08，（p<0.05）。HBP和NBP受试者的空腹和2小时血浆葡萄糖浓度分别为5.5±0.2、7.2±0.3 mmol/l和5.2±0.1、6.8±0.2 mmol/l（p>0.05）。相应的空腹和2小时胰岛素浓度分别为10.0±0.7、8.0±0.4 uU/ml和47.3±3.7、37.3±2.5 uU/ml（p<0.05）。HBP组和NBP组的胰岛素抵抗指数（HOMA-IR）分别为2.49±0.2和1.95±0.13（p<0.05）。两组的空腹和刺激后的C肽、血脂和高密度脂蛋白浓度相似。发现血压与血脂、高密度脂蛋白、空腹和刺激后的胰岛素及C肽浓度之间存在相关性，以及空腹胰岛素和HOMA-IR与血脂和高密度脂蛋白浓度之间存在相关性。多元回归分析显示，空腹胰岛素和HOMA-IR对血压变化无显著影响。
结论/解读：我们发现高血压加纳受试者中存在高胰岛素血症、胰岛素抵抗和腹部肥胖的聚集现象，但胰岛素抵抗、高血压与致动脉粥样硬化的脂质和脂蛋白谱之间存在分离。
