Silva Eliana A, Flexa Fernando, Zanella Maria Teresa
Universidade Federal de São Paulo-UNIFESP, Escola Paulista de Medicina-EPM-São Paulo, SP-Brazil.
Arq Bras Cardiol. 2007 Aug;89(2):77-82, 86-92. doi: 10.1590/s0066-782x2007001400003.
To evaluate the relationship between central obesity, hyperinsulinemia and arterial hypertension with left ventricular mass and geometry in women.
This study included 70 women (35-68 years), divided into four groups according to the presence of central obesity and hypertension. Visceral fat area was determined. Blood glucose and plasma insulin were determined before and two hours after an oral 75 g glucose load and the patients were submitted to cardilogical evaluation.
Compared to NT-OB, HT-OB presented higher levels of plasma insulin at 2h-OGTT (127.5 +/- 73.0 vs 86.8 +/- 42.7 microU/ml; p = 0.05), and reduced E wave/A wave ratio (E/A) (0.8 +/- 0.1 vs 1.2 +/- 0.3; p < 0.05). Compared to NT-NO, HT-NO showed higher insulin levels before glucose load (7.46 +/- 3.1 vs 4.32 +/- 2.1 microU/ml; p < 0.05), higher HOMAr (1.59 +/- 0.72 vs 0.93 +/- 0.48 mmol x mU/l2; p = 0.006), higher leptin level (19.1 +/- 9.6 vs 7.4 +/- 3.5 ng/ml; p = 0.028), greater VF area (84.40 +/- 55.7 vs 37.50 +/- 23.0 cm2; p = 0.036), increased IVSTd (9.6 +/- 1.2 vs 8.2 +/- 1.7 mm; p <0.05) and (LVM/height) (95.8 +/- 22.3 vs 78.4 +/- 15.5 g/m; p < 0.05). Multiple linear regression analysis showed age, BMI and fasting glucose as determinants on LVM/height (R2 = 0.59; p < 0.05).
Our results indicate an association among hypertension, central obesity and left ventricular hypertrophy through increases in sympathetic activity and insulin resistance.
评估女性中心性肥胖、高胰岛素血症和动脉高血压与左心室质量及几何形态之间的关系。
本研究纳入70名女性（35 - 68岁），根据是否存在中心性肥胖和高血压分为四组。测定内脏脂肪面积。在口服75克葡萄糖负荷前及负荷后两小时测定血糖和血浆胰岛素，并对患者进行心脏评估。
与非肥胖非高血压组（NT - OB）相比，肥胖高血压组（HT - OB）在口服葡萄糖耐量试验2小时时血浆胰岛素水平更高（127.5±73.0对86.8±42.7微单位/毫升；p = 0.05），E波/A波比值（E/A）降低（0.8±0.1对1.2±0.3；p < 0.05）。与非肥胖非高血压组（NT - NO）相比，非肥胖高血压组（HT - NO）在葡萄糖负荷前胰岛素水平更高（7.46±3.1对4.32±2.1微单位/毫升；p < 0.05），稳态模型评估胰岛素抵抗指数（HOMAr）更高（1.59±0.72对0.93±0.48毫摩尔×微单位/升²；p = 0.006），瘦素水平更高（19.1±9.6对7.4±3.5纳克/毫升；p = 0.028），内脏脂肪面积更大（84.40±55.7对37.50±23.0平方厘米；p = 0.036），室间隔舒张末期厚度（IVSTd）增加（9.6±1.2对8.2±1.7毫米；p <0.05）以及左心室质量/身高（LVM/height）增加（95.8±22.3对78.4±15.5克/米；p < 0.05）。多元线性回归分析显示年龄、体重指数（BMI）和空腹血糖是左心室质量/身高的决定因素（R² = 0.59；p < 0.05）。
我们的结果表明，高血压、中心性肥胖与左心室肥厚之间存在关联，其机制是交感神经活动增加和胰岛素抵抗。
