Fossum E, Høieggen A, Moan A, Rostrup M, Nordby G, Kjeldsen S E
Department of Internal Medicine, Ullevaal University Hospital, Oslo, Norway.
Hypertension. 1998 Nov;32(5):838-43. doi: 10.1161/01.hyp.32.5.838.
Insulin resistance is a part of the metabolic cardiovascular syndrome. We aimed to test the hemodynamic hypothesis of insulin resistance, which suggests that a decreased skeletal muscle blood supply with subsequent reduced nutritional flow causes insulin resistance in skeletal muscle. We assessed determinants of peripheral blood flow such as maximal forearm blood flow (MFBF), minimal forearm vascular resistance (MFVR), and whole blood viscosity (WBV) in 27 young men with borderline elevation of blood pressure. Insulin sensitivity measured as glucose disposal rate (GDR) correlated with MFBF (r=0.55, P=0.003), MFVR (r=-0.58, P=0. 002), and WBV (r=-0.39, P=0.046 at shear rate 201 s-1). There was no correlation between GDR and myocardial thickness or left ventricular mass. In a stepwise multiple regression analysis, MFVR and WBV explained 54% of the variation in GDR. The relative increase in mean arterial blood pressure during a mental stress test, as a marker of reactivity or an alert reaction, was correlated with MFVR (r=0.56, P=0.002) and inversely with GDR (r=-0.45, P=0.018) and MFBF (r=-0.49, P=0.01) but not with cardiac dimensions. In a stepwise multiple regression analysis, 48% of the increase in blood pressure during a mental stress test was explained by MFVR and WBV. Fasting insulin correlated with MFVR (r=0.41, P=0.036) and GDR (r=-0.62, P=0.001). These data show a positive association between the appearance of peripheral structural vascular changes as quantified through a hemodynamic technique and insulin resistance in young men with borderline elevation of blood pressure. The cause-effect relationship of this finding needs further evaluations.
胰岛素抵抗是代谢性心血管综合征的一部分。我们旨在验证胰岛素抵抗的血流动力学假说，该假说认为骨骼肌血液供应减少以及随之而来的营养物质流动减少会导致骨骼肌出现胰岛素抵抗。我们评估了27名血压临界升高的年轻男性的外周血流决定因素，如最大前臂血流量（MFBF）、最小前臂血管阻力（MFVR）和全血粘度（WBV）。以葡萄糖处置率（GDR）衡量的胰岛素敏感性与MFBF（r = 0.55，P = 0.003）、MFVR（r = -0.58，P = 0.002）和WBV（在剪切速率201 s-1时r = -0.39，P = 0.046）相关。GDR与心肌厚度或左心室质量之间无相关性。在逐步多元回归分析中，MFVR和WBV解释了GDR变化的54%。作为反应性或警觉反应指标的精神应激试验期间平均动脉血压的相对升高与MFVR（r = 0.56，P = 0.002）相关，与GDR（r = -0.45，P = 0.018）和MFBF（r = -0.49，P = 0.01）呈负相关，但与心脏大小无关。在逐步多元回归分析中，精神应激试验期间血压升高的48%可由MFVR和WBV解释。空腹胰岛素与MFVR（r = 0.41，P = 0.036）和GDR（r = -0.62，P = 0.001）相关。这些数据表明，通过血流动力学技术量化的外周结构性血管变化的出现与血压临界升高的年轻男性的胰岛素抵抗之间存在正相关。这一发现的因果关系需要进一步评估。
