Marita A R, Desai A, Mokal R, Agarkar R Y, Dalal K P
Sir Hurkisondas Nurrotumdas Medical Research Society, Mumbai, India.
Endocr Res. 1998 May;24(2):215-33. doi: 10.1080/07435809809135530.
To investigate the relationship between insulin resistance and electrocardiographic changes in hypertension in the absence of confounding influences, plasma glucose and insulin responses to oral glucose were studied in 26 normotensive and 38 hypertensive subjects. Resting ECG was taken and classified into normal or abnormal using the Minnesota code. Among the 38 subjects, 16 had ECG abnormalities. All the hypertensive subjects had normal glucose tolerance. Serum insulin response of hypertensive subjects with ECG changes was 43% higher than those of hypertensive subjects without ECG changes and of normotensive subjects. The ratio AUC glucose/AUC insulin, a measure of insulin sensitivity was significantly reduced in subjects with abnormal ECG. Serum LDL cholesterol was significantly elevated and was the highest in hypertensive subjects with abnormal ECG. The ratio, Total Cholesterol/HDL Cholesterol was elevated to 5.81+/-0.47. I(125)-insulin binding to erythrocytes from 6 normotensive subjects, and 16 hypertensive subjects (8 with and 8 without ECG abnormalities) indicated 50% reduction in insulin receptor number in both the groups of hypertensive subjects compared to normotensive subjects. Multiple logistic regression analysis using mean blood pressure, serum total cholesterol, LDL cholesterol/HDL cholesterol, sex, insulin level at 60 min in OGTT, treatment, serum triglyceride, presence of family history of diabetes, CHD, hypertension and tobacco as independent variables causing ECG changes, revealed correct classification in 84% of cases. Among the variables, insulin level in OGTT contributed the most to ECG abnormalities. The data suggest that in the non obese, non diabetic Asian Indian hypertensive subjects, the presence of electrocardiographic abnormalities might be partly related to hyperinsulinemia or insulin resistance in them.
为在无混杂影响的情况下研究高血压患者胰岛素抵抗与心电图改变之间的关系，对26名血压正常者和38名高血压患者进行了口服葡萄糖后的血糖和胰岛素反应研究。记录静息心电图，并使用明尼苏达编码将其分类为正常或异常。在38名受试者中，16人有心电图异常。所有高血压患者糖耐量均正常。有心电图改变的高血压患者的血清胰岛素反应比无心电图改变的高血压患者和血压正常者高43%。心电图异常的受试者中，葡萄糖曲线下面积/胰岛素曲线下面积（衡量胰岛素敏感性的指标）显著降低。血清低密度脂蛋白胆固醇显著升高，在有心电图异常的高血压患者中最高。总胆固醇/高密度脂蛋白胆固醇比值升高至5.81±0.47。对6名血压正常者以及16名高血压患者（8名有心电图异常，8名无心电图异常）的红细胞进行¹²⁵I -胰岛素结合试验，结果显示，与血压正常者相比，两组高血压患者的胰岛素受体数量均减少了50%。以平均血压、血清总胆固醇、低密度脂蛋白胆固醇/高密度脂蛋白胆固醇、性别、口服葡萄糖耐量试验60分钟时的胰岛素水平、治疗情况、血清甘油三酯、糖尿病家族史、冠心病、高血压和吸烟情况作为导致心电图改变的自变量进行多因素逻辑回归分析，结果显示84%的病例分类正确。在这些变量中，口服葡萄糖耐量试验中的胰岛素水平对心电图异常的影响最大。数据表明，在非肥胖、非糖尿病的亚洲印度裔高血压患者中，心电图异常的存在可能部分与他们的高胰岛素血症或胰岛素抵抗有关。
