高血压患者后代的胰岛素抵抗
Insulin resistance in offspring of hypertensive parents.
作者信息
Beatty O L, Harper R, Sheridan B, Atkinson A B, Bell P M
机构信息
Sir George E Clark Metabolic Unit, Royal Victoria Hospital, Belfast.
出版信息
BMJ. 1993 Jul 10;307(6896):92-6. doi: 10.1136/bmj.307.6896.92.
OBJECTIVE
To determine if insulin resistance is present in normotensive adults at increased risk of developing hypertension.
DESIGN
Normotensive subjects with at least one hypertensive parent were paired with offspring of normotensive parents (controls), being matched for age, sex, social class, and physical activity.
SETTING
Outpatient clinic.
SUBJECTS
30 paired subjects (16 men and 14 women) with and without a family history of hypertension, aged 18-32, with a body mass index < 25 kg/m2, with blood pressure < 130/85 mm Hg, and not taking drugs.
INTERVENTIONS
Euglycaemic glucose clamp (two hour infusion of insulin 1 mU/kg/min) and intravenous glucose tolerance test (injection of 100 ml 20% glucose).
MAIN OUTCOME MEASURES
Insulin mediated glucose disposal and insulin secretion.
RESULTS
The offspring of hypertensive parents had slightly higher blood pressure than did the controls (mean 117 (SD 6) v 108 (5) mm Hg systolic, p = 0.013; 76 (7) v 67 (6) mm Hg diastolic, p = 0.017). Their insulin mediated glucose disposal was lower than that of controls (29.5 (6.5) v 40.1 (8.6) mumol/kg/min, p = 0.002), but, after adjustment for blood pressure, the difference was not significant (difference 6.9 (95% confidence interval -1.5 to 15.3), p = 0.10). Insulin secretion in the first hour after injection of glucose was slightly but not significantly higher in the offspring of hypertensive patients (9320 (5484) v 6723 (3751) pmol.min/l). The two groups had similar concentrations of plasma glucose (5.2 (0.3) v 5.1 (0.4) mmol/l), serum cholesterol (4.4 (0.8) v 4.6 (0.8) mmol/l), serum triglyceride (0.89 (0.52) v 0.68 (0.27) mmol/l), and serum low density lipoprotein cholesterol (2.81 (0.65) v 2.79 (0.61) mmol/l). The offspring of hypertensive parents, however, had lower serum concentrations of high density lipoprotein cholesterol (1.24 (0.31) v 1.56 (0.35) mmol/l, p = 0.002) and higher serum concentrations of non-esterified fatty acids (0.7 (0.4) v 0.4 (0.4) mmol/l, p = 0.039).
CONCLUSIONS
Young normotensive subjects who are at increased risk of developing hypertension are insulin resistant.
目的
确定高血压发病风险增加的血压正常成年人是否存在胰岛素抵抗。
设计
将至少有一位高血压父母的血压正常受试者与血压正常父母的后代（对照组）配对，根据年龄、性别、社会阶层和体力活动进行匹配。
地点
门诊诊所。
受试者
30对受试者（16名男性和14名女性），有或无高血压家族史，年龄在18 - 32岁之间，体重指数<25kg/m²，血压<130/85mmHg，且未服用药物。
干预措施
正常血糖钳夹试验（以1mU/kg/min的速率输注胰岛素2小时）和静脉葡萄糖耐量试验（注射100ml 20%葡萄糖）。
主要观察指标
胰岛素介导的葡萄糖处置和胰岛素分泌。
结果
高血压父母的后代血压略高于对照组（收缩压均值117（标准差6）对108（5）mmHg，p = 0.013；舒张压76（7）对67（6）mmHg，p = 0.017）。他们的胰岛素介导的葡萄糖处置低于对照组（29.5（6.5）对40.1（8.6）μmol/kg/min，p = 0.002），但在调整血压后，差异无统计学意义（差异6.9（95%置信区间 -1.5至15.3），p = 0.10）。高血压患者后代在注射葡萄糖后第一小时的胰岛素分泌略高但无统计学意义（9320（5484）对6723（3751）pmol·min/l）。两组的血浆葡萄糖浓度相似（5.2（0.3）对5.1（0.4）mmol/l），血清胆固醇（4.4（0.8）对4.6（0.8）mmol/l），血清甘油三酯（0.89（0.52）对0.68（0.27）mmol/l），以及血清低密度脂蛋白胆固醇（2.81（0.65）对2.79（0.61）mmol/l）。然而，高血压父母的后代血清高密度脂蛋白胆固醇浓度较低（1.24（0.31）对1.56（0.35）mmol/l，p = 0.002），血清非酯化脂肪酸浓度较高（0.7（0.4）对0.4（0.4）mmol/l，p = 0.039）。
结论
高血压发病风险增加的年轻血压正常受试者存在胰岛素抵抗。
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