de Jongh Renate T, Ijzerman Richard G, Serné Erik H, van Weissenbruch Mirjam M, Voordouw Jasper J, Delemarre-van de Waal Henriette A, Stehouwer Coen D A
Department of Internal Medicine, Institute for Cardiovascular Research-Vrije Universiteit, VU University Medical Center, De Boelelaan, Amsterdam, The Netherlands.
Clin Sci (Lond). 2007 Jul;113(2):83-91. doi: 10.1042/CS20060357.
The relationships of cortisol with elevated blood pressure and insulin resistance are likely to be the result of a complex interplay of different mechanisms. We hypothesize that cortisol is associated with impaired microvascular function and that this contributes to cortisol-associated high blood pressure and insulin resistance. We examined 24 h urinary free cortisol excretion in 56 healthy adults (26 women). Blood pressure was assessed by 24 h ambulatory measurements. Insulin sensitivity was determined using the hyperinsulinaemic euglycaemic clamp technique. Skin capillary recruitment after arterial occlusion was visualized with videomicroscopy and endothelium-(in)dependent vasodilation was evaluated with iontophoresis of acetylcholine and sodium nitroprusside combined with laser Doppler fluxmetry. Men were characterized by higher urinary cortisol excretion [median (interquartile range), 162 (130-194) compared with 118 (99-156) nmol/24 h, P<0.05]. In women, but not in men, urinary cortisol excretion was associated with impaired capillary recruitment (r=-0.66, P<0.001), higher systolic blood pressure (r=0.64, P<0.001) and lower insulin sensitivity (r=-0.43, P<0.05). Urinary cortisol excretion was not associated with endothelium-(in)dependent vasodilation in men or women. Regression analysis demonstrated that capillary recruitment statistically explained 37% of the association between urinary cortisol and blood pressure in women. Capillary recruitment did not explain part of the association between urinary cortisol and insulin sensitivity. In conclusion, urinary cortisol excretion is inversely associated with capillary recruitment in women, but not in men, and capillary recruitment explains part of the cortisol-blood pressure relationship. These data suggest that, in women, impairment of capillary function mediates some of the adverse effects of cortisol and thus may provide a target to prevent such adverse effects.
皮质醇与血压升高和胰岛素抵抗之间的关系可能是不同机制复杂相互作用的结果。我们推测皮质醇与微血管功能受损有关，且这会导致与皮质醇相关的高血压和胰岛素抵抗。我们检测了56名健康成年人（26名女性）24小时尿游离皮质醇排泄量。通过24小时动态测量评估血压。使用高胰岛素正常血糖钳夹技术测定胰岛素敏感性。用视频显微镜观察动脉闭塞后皮肤毛细血管的募集情况，并用乙酰胆碱和硝普钠离子导入结合激光多普勒血流仪评估内皮依赖性和非内皮依赖性血管舒张功能。男性的尿皮质醇排泄量较高[中位数（四分位间距），162（130 - 194）与118（99 - 156）nmol/24小时相比，P<0.05]。在女性中，而非男性中，尿皮质醇排泄量与毛细血管募集受损相关（r = -0.66，P<0.001）、收缩压较高（r = 0.64，P<0.001）以及胰岛素敏感性较低（r = -0.43，P<0.05）。男性和女性的尿皮质醇排泄量均与内皮依赖性和非内皮依赖性血管舒张功能无关。回归分析表明，在女性中，毛细血管募集在统计学上解释了尿皮质醇与血压之间关联的37%。毛细血管募集并不能解释尿皮质醇与胰岛素敏感性之间关联的部分情况。总之，尿皮质醇排泄量在女性中与毛细血管募集呈负相关，而在男性中并非如此，且毛细血管募集解释了皮质醇与血压关系的部分情况。这些数据表明，在女性中，毛细血管功能受损介导了皮质醇的一些不良影响，因此可能为预防此类不良影响提供一个靶点。
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