Vlasáková Zuzana, Pelikánová Terezie, Karasová Ludmila, Skibová Jelena
Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Metabolism. 2004 Apr;53(4):469-75. doi: 10.1016/j.metabol.2003.10.030.
Hyperinsulinemia and insulin resistance are commonly observed in essential hypertension, which is part of the metabolic syndrome. The aim of this study was to examine whether insulin secretion abnormalities or alterations in insulin sensitivity and glucose tolerance are also present in healthy men, offspring of patients with essential hypertension. Twelve young (27 +/- 3.6 years), lean normotensive offspring were compared with 14 age-, sex-, and body mass index (BMI)-matched controls without a family history of hypertension, diabetes mellitus, and coronary heart disease. We studied glucose tolerance, insulin secretion, and sensitivity using 10-hour hyperglycemic and 10-hour hyperinsulinemic-euglycemic clamps (HIC). Glucose tolerance was comparable in the offspring and controls. However, the offspring had higher insulin and C-peptide levels during the hyperglycemic clamp (HGC) compared with controls (P <.05). There was no difference in the early phase of insulin secretion between the groups. The insulin sensitivity index (glucose infusion rate/serum insulin) was significantly lower in the offspring during both clamps. Moreover, the offspring had higher systolic (P <.001) and diastolic (P <.001) blood pressure and had higher serum cholesterol (P <.01) and triglyceride (P <.05) levels. Apparently healthy, young, lean individuals with a genetic predisposition to essential hypertension and with normal glucose tolerance had higher insulin secretion and lower insulin sensitivity than controls. These abnormalities, together with higher blood pressure and altered lipid metabolism, may play a role in the development of hypertension and an increased risk of cardiovascular morbidity and mortality in these individuals.
高胰岛素血症和胰岛素抵抗在原发性高血压中较为常见，原发性高血压是代谢综合征的一部分。本研究的目的是检验原发性高血压患者的健康男性后代是否也存在胰岛素分泌异常或胰岛素敏感性及糖耐量改变。将12名年轻（27±3.6岁）、体型偏瘦的血压正常后代与14名年龄、性别和体重指数（BMI）相匹配且无高血压、糖尿病和冠心病家族史的对照者进行比较。我们使用10小时高血糖钳夹试验（HGC）和10小时高胰岛素-正常血糖钳夹试验（HIC）研究糖耐量、胰岛素分泌和敏感性。后代与对照者的糖耐量相当。然而，与对照者相比，后代在高血糖钳夹试验（HGC）期间的胰岛素和C肽水平更高（P<.05）。两组间胰岛素分泌的早期阶段无差异。在两种钳夹试验中，后代的胰岛素敏感性指数（葡萄糖输注速率/血清胰岛素）均显著较低。此外，后代的收缩压（P<.001）和舒张压（P<.001）更高，血清胆固醇（P<.01）和甘油三酯（P<.05）水平也更高。具有原发性高血压遗传易感性且糖耐量正常的明显健康、年轻、体型偏瘦个体，其胰岛素分泌更高，胰岛素敏感性低于对照者。这些异常，连同较高的血压和脂质代谢改变，可能在这些个体的高血压发生以及心血管发病和死亡风险增加中起作用。
