Cigolini M, Targher G, Seidell J C, Tonoli M, Schiavon R, Agostino G, De Sandre G
Institute of Clinical Medicine, University of Verona, Italy.
J Hypertens. 1995 Jun;13(6):659-66. doi: 10.1097/00004872-199506000-00013.
To investigate the relationship between blood pressure and the plasma fibrinolytic system and to verify whether this association was independent or mediated by one or more potential confounding factor.
A random sample of 94 males aged 38 years subdivided into normotensives, hypertensives and those hypertensives with the highest blood pressure values.
Overall and regional obesity, blood lipids, fasting and 2-h post-load glucose, C-peptide and insulin levels, and main behavioural variables, including adipose tissue fatty acid composition (an objective index of dietary fat intake), were measured. The plasma fibrinolytic system was evaluated by determining activities and total plasma concentrations of both tissue-type plasminogen activator before and after venous occlusion, and its inhibitor plasminogen activator inhibitor type-1 (PAI-1).
PAI-1 activity was significantly higher in the hypertensives than in the normotensives. PAI-1 antigen tended to parallel PAI-1 activity, and levels of tissue-type plasminogen activator antigen and activity tended to be lower in the hypertensives at baseline and after venous occlusion, but not significantly different from those in the normotensives. The hypertensives also had significantly higher body mass index and body fat content (measured by bio-impedance), increased plasma triglycerides, uric acid, fasting and 2-h glucose, C-peptide and insulin concentrations. In univariate linear regression analysis both systolic and diastolic blood pressures were found to be positively correlated with PAI-1 levels (r = 0.27, P < 0.01, for both). This correlation was maintained after adjustment for total body fat, fasting glucose, fasting insulin concentration or adipose tissue alpha-linolenic acid; however, it was no longer significant after adjustment for plasma 2-h insulin, 2-h C-peptide, 2-h glucose or triglyceride levels. Multivariate regression analysis revealed that only 2-h insulin and triglyceride concentration showed an independent association with PAI-1 levels.
This study confirms that, in 38-year-old males, hypertension is associated with increased PAI-1 activity. It supports the possibility that the relationship between blood pressure and PAI-1 may reflect the overall effect of the insulin resistance syndrome (in particular hyperinsulinaemia and hypertriglyceridaemia) rather than a direct effect of blood pressure on the fibrinolytic system.
研究血压与血浆纤溶系统之间的关系，并验证这种关联是独立的，还是由一个或多个潜在混杂因素介导的。
从94名38岁男性中随机抽样，分为血压正常者、高血压患者以及血压值最高的高血压患者。
测量总体和局部肥胖、血脂、空腹及负荷后2小时血糖、C肽和胰岛素水平，以及主要行为变量，包括脂肪组织脂肪酸组成（饮食脂肪摄入的客观指标）。通过测定静脉闭塞前后组织型纤溶酶原激活物的活性和血浆总浓度及其抑制剂1型纤溶酶原激活物抑制剂（PAI-1）来评估血浆纤溶系统。
高血压患者的PAI-1活性显著高于血压正常者。PAI-1抗原倾向于与PAI-1活性平行，组织型纤溶酶原激活物抗原和活性水平在基线和静脉闭塞后在高血压患者中往往较低，但与血压正常者无显著差异。高血压患者的体重指数和体脂含量（通过生物电阻抗测量）也显著更高，血浆甘油三酯、尿酸、空腹及负荷后2小时血糖、C肽和胰岛素浓度升高。在单变量线性回归分析中，收缩压和舒张压均与PAI-1水平呈正相关（两者r = 0.27，P < 0.01）。在调整总体脂肪、空腹血糖、空腹胰岛素浓度或脂肪组织α-亚麻酸后，这种相关性仍然存在；然而，在调整血浆负荷后2小时胰岛素、负荷后2小时C肽、负荷后2小时血糖或甘油三酯水平后，这种相关性不再显著。多变量回归分析显示，只有负荷后2小时胰岛素和甘油三酯浓度与PAI-1水平呈独立关联。
本研究证实，在38岁男性中，高血压与PAI-1活性增加有关。它支持血压与PAI-1之间的关系可能反映胰岛素抵抗综合征（特别是高胰岛素血症和高甘油三酯血症）的总体效应，而非血压对纤溶系统的直接作用这一可能性。
