Mathew Boban, Patel Sanjeev B, Reams Garry P, Freeman Ronald H, Spear Robert M, Villarreal Daniel
Department of Internal Medicine, SUNY Upstate Medical University, and Veterans Affairs Medical Center, Syracuse, New York 13210, USA.
Am J Med Sci. 2007 Jul;334(1):23-30. doi: 10.1097/MAJ.0b013e3180959e4e.
The incidence and prevalence of obesity has risen markedly in the last decade, and this epidemic represents a serious health hazard with significant morbidity and mortality. Although hypertension is recognized as one of the most serious consequences of obesity, its pathophysiology remains incompletely understood. Contemporary research suggests that the recently discovered hormone leptin may represent a common link between these 2 pathologic conditions. Leptin is primarily synthesized and secreted by adipocytes. One of the major functions of this hormone is the control of energy balance. By binding to receptors in the hypothalamus, it reduces food intake and promotes elevation in temperature and energy expenditure. In addition, increasing evidence suggests that leptin, through both direct and indirect actions, may play an important role in cardiovascular and renal functions. Although the relevance of endogenous leptin needs further clarification for the control of renal sodium excretion and vascular tone, it appears to be a potential pressure and volume-regulating factor in normal situations. However, in conditions of chronic hyperleptinemia, such as obesity, leptin may function pathophysiologically for the development of hypertension as well as cardiac and renal disease. Thus, in addition to weight control, reduction of circulating leptin may confer cardiovascular and renal protective effects in patients with obesity-hypertension.
在过去十年中，肥胖的发病率和患病率显著上升，这种流行态势构成了严重的健康危害，具有很高的发病率和死亡率。尽管高血压被认为是肥胖最严重的后果之一，但其病理生理学仍未完全明了。当代研究表明，最近发现的激素瘦素可能是这两种病理状况之间的共同联系。瘦素主要由脂肪细胞合成和分泌。这种激素的主要功能之一是控制能量平衡。通过与下丘脑的受体结合，它可减少食物摄入，并促进体温升高和能量消耗。此外，越来越多的证据表明，瘦素通过直接和间接作用，可能在心血管和肾脏功能中发挥重要作用。尽管内源性瘦素对肾钠排泄和血管张力控制的相关性尚需进一步阐明，但在正常情况下它似乎是一种潜在的压力和容量调节因子。然而，在慢性高瘦素血症的情况下，如肥胖症，瘦素在高血压以及心脏和肾脏疾病的发生发展中可能具有病理生理学作用。因此，除了控制体重外，降低循环中的瘦素水平可能对肥胖型高血压患者具有心血管和肾脏保护作用。
