高血压患者的左心室肥厚与胰岛素抵抗代谢综合征相关。

Left ventricular hypertrophy in hypertension is associated with the insulin resistance metabolic syndrome.

作者信息

Lind L, Andersson P E, Andrén B, Hänni A, Lithell H O

机构信息

Department of Internal Medicine, University Hospital, Uppsala, Sweden.

出版信息

J Hypertens. 1995 Apr;13(4):433-8.

PMID:7629404

Abstract

OBJECTIVE

To investigate whether left ventricular hypertrophy is associated with the insulin resistance syndrome.

METHODS

Fifty patients with untreated hypertension were evaluated by recording office blood pressure during regular antihypertensive treatment and 24-h ambulatory blood pressure and office blood pressure after 4-6 weeks on placebo, echocardiography with M-mode measurements of left ventricular wall thickness and pulsed-wave Doppler measurements of mitral flow in diastole and the hyperinsulinaemic euglycaemic clamp, for determination of insulin sensitivity.

RESULTS

The left ventricular wall thickness was found to be significantly related to blood pressure [r = 0.44, P < 0.004 for 24-h ambulatory systolic blood pressure (SBP)], fasting insulin level (r = 0.32, P < 0.03) and haematocrit level (r = 0.37, P < 0.009) and inversely related to insulin sensitivity (r = -0.59, P < 0.0001). Multiple regression analysis with these relationships together with confounding factors age, sex, body mass index and waist: hip ratio as independent variables showed insulin sensitivity to be the only significant variable, explaining 43% of the variation in left ventricular wall thickness, whereas 24-h ambulatory SBP explained a further 7%. Left ventricular diastolic filling, as evaluated by the mitral Doppler early: atrial ratio, was significantly correlated with insulin sensitivity (r = 0.42, P < 0.003) and inversely related to blood pressure (r = -0.41, P < 0.02 for 24-h ambulatory SBP), left ventricular wall thickness (r = -0.34, P < 0.02) and serum fibrinogen level (r = -0.63, P < 0.0001). However, multiple regression analysis showed that insulin sensitivity was more closely related to diastolic filling than to blood pressure or left ventricular wall thickness.

CONCLUSION

The present study showed left ventricular wall thickness to be closely associated with insulin resistance. Because diastolic dysfunction of the left ventricle was also related to a decreased insulin sensitivity, these findings suggest that left ventricular hypertrophy and diastolic dysfunction are associated with the insulin resistance metabolic syndrome.

摘要

目的

研究左心室肥厚是否与胰岛素抵抗综合征相关。

方法

对50例未经治疗的高血压患者进行评估，记录其在常规降压治疗期间的诊室血压、24小时动态血压以及服用安慰剂4 - 6周后的诊室血压，采用M型超声心动图测量左心室壁厚度，脉冲波多普勒测量二尖瓣舒张期血流，并进行高胰岛素正常血糖钳夹试验以测定胰岛素敏感性。

结果

发现左心室壁厚度与血压显著相关[r = 0.44，24小时动态收缩压（SBP）的P < 0.004]、空腹胰岛素水平（r = 0.32，P < 0.03）和血细胞比容水平（r = 0.37，P < 0.009），与胰岛素敏感性呈负相关（r = -0.59，P < 0.0001）。以这些关系以及混杂因素年龄、性别、体重指数和腰臀比作为自变量进行多元回归分析，结果显示胰岛素敏感性是唯一显著的变量，可解释左心室壁厚度变化的43%，而24小时动态SBP可进一步解释7%。通过二尖瓣多普勒E/A比值评估的左心室舒张期充盈与胰岛素敏感性显著相关（r = 0.42，P < 0.003），与血压呈负相关（24小时动态SBP的r = -0.41，P < 0.02）、左心室壁厚度（r = -0.34，P < 0.02）和血清纤维蛋白原水平（r = -0.63，P < 0.0001）。然而，多元回归分析表明胰岛素敏感性与舒张期充盈的关系比与血压或左心室壁厚度更为密切。