Lind L, Berne C, Lithell H
Department of Internal Medicine, University Hospital, Uppsala, Sweden.
J Hypertens. 1995 Dec;13(12 Pt 1):1457-62.
To establish the prevalence of insulin resistance in hypertensive subjects.
The euglycaemic hyperinsulinaemic clamp was performed in 420 hypertensive patients taking no antihypertensive medication and in 51 age- and sex-matched healthy controls. No subjects with known diabetes mellitus or fasting hyperglycaemia were included in the study.
The mean value for insulin-mediated glucose uptake (M-value at clamp) in the healthy control group (8.2 mg/kg per min) -2 SD was chosen as the cutoff limit for insulin resistance (4.4 mg/kg per min). At this cutoff limit, 27% of the hypertensive subjects were insulin resistant (mean value 3.1 mg/kg per min in this group, range 0.7-4.3). A similar prevalence of insulin resistance in hypertensive patients was found (31%) if the 95th percentile of the non-normally distributed insulin sensitivity index (M/I at clamp) was used to define the cutoff limit for insulin resistance: (4.4 mg/kg per min)/(mU/l x 100). In the insulin-resistant group, 50% showed elevated levels of serum triglycerides (> 2.0 mmol/l), 50% had abdominal obesity (waist:hip ratio > 0.95), 20% had elevated levels of serum uric acid (> 400 mumol/l) and 48% had low high-density lipid (HDL)-cholesterol levels (< 1.0 mmol/l). Half of the insulin-resistant hypertensives but only 20% of the non-insulin resistant group had two or more of these other four metabolic impairments (P < 0.001). Insulin resistance in hypertension was also associated with an increased heart rate (+3 beats/min faster than in non-insulin resistant hypertensive patients, P < 0.01), but no significant differences in blood pressure were found between insulin resistant and non-insulin resistant hypertensive patients.
When insulin resistance was defined as an M-value at clamp of < 4.4 mg/kg per min, based on calculations from a healthy control sample, about 25% of a sample of hypertensive subjects, taking no antihypertensive treatment and with no history of diabetes mellitus or hyperglycaemia, was found to be insulin resistant. This group of insulin-resistant hypertensives also displayed a high degree of clustering of other metabolic impairments.
确定高血压患者中胰岛素抵抗的患病率。
对420名未服用抗高血压药物的高血压患者以及51名年龄和性别匹配的健康对照者进行了正常血糖高胰岛素钳夹试验。研究未纳入已知患有糖尿病或空腹血糖过高的受试者。
健康对照组胰岛素介导的葡萄糖摄取平均值（钳夹试验中的M值）（8.2mg/kg每分钟）减去2个标准差被选为胰岛素抵抗的临界值（4.4mg/kg每分钟）。在此临界值下，27%的高血压受试者存在胰岛素抵抗（该组平均值为3.1mg/kg每分钟，范围为0.7 - 4.3）。如果使用非正态分布的胰岛素敏感性指数（钳夹试验中的M/I）的第95百分位数来定义胰岛素抵抗的临界值（4.4mg/kg每分钟）/（mU/l×100），则高血压患者中胰岛素抵抗的患病率相似（31%）。在胰岛素抵抗组中，50%的患者血清甘油三酯水平升高（>2.0mmol/l），50%有腹型肥胖（腰臀比>0.95），20%血清尿酸水平升高（>400μmol/l），48%高密度脂蛋白（HDL）胆固醇水平低（<1.0mmol/l）。一半的胰岛素抵抗型高血压患者，但非胰岛素抵抗组中只有20%有上述其他四种代谢障碍中的两种或更多种（P<0.001）。高血压中的胰岛素抵抗还与心率增加有关（比非胰岛素抵抗型高血压患者快3次/分钟，P<0.01），但胰岛素抵抗型和非胰岛素抵抗型高血压患者之间血压无显著差异。
根据健康对照样本计算，当将胰岛素抵抗定义为钳夹试验中的M值<4.4mg/kg每分钟时，在未接受抗高血压治疗且无糖尿病或高血糖病史的高血压受试者样本中，约25%被发现存在胰岛素抵抗。这组胰岛素抵抗型高血压患者还表现出其他代谢障碍的高度聚集。
