肥胖患者运动血压与血糖、血浆胰岛素水平的关系

目的探讨肥胖患者运动血压与血糖、血浆胰岛素水平的关系.方法选取完成次极量踏车运动试验的49例肥胖患者(Obesity)及45例体重正常的对照组(Control),比较其静态血压(RBP)、运动血压(PBP)及空腹和口服75克葡萄糖2小时后血糖、血浆胰岛素水平.并分析肥胖组中合并运动性高血压(PBP1)与运动血压正常者(PBP2)的血糖、胰岛素水平.结果静态下两组血压无显著差异,负荷试验后达到运动性高血压标准者,肥胖组21/49例(42.8%),对照组8/45例(17.8%),P<0.01;运动后肥胖组的收缩压与舒张压均较对照组升高,特别是收缩压升高更明显;两组空腹血糖无显著差异,肥胖组的空腹胰岛素、餐后2小时血糖及胰岛素均明显高于对照组;肥胖组中伴运动性高血压者的餐后2小时血糖、胰岛素水平均高于不伴运动性高血压的肥胖患者.结论肥胖患者血压、血糖升高可能与胰岛素水平升高有关.     

肥胖患者运动性高血压的临床研究

目的比较肥胖组与正常对照组运动负荷后的血压变化,探讨运动性高血压对肥胖患者高血压病早期诊断的临床意义.方法观察静态及次极量踏车运动试验后血压变化,两组进行对比分析,并行24小时动态血压检查.结果静态下两组血压无差异,运动后肥胖组血压超过标准者(42.86%)明显高于对照组(13.33%);动态血压分析显示肥胖组24小时及日间收缩压高于对照组,舒张压及夜间血压无显著差异.结论肥胖患者运动性高血压患病率明显高于对照组,提示运动性高血压对肥胖者高血压病的早期诊断有一定参考价值.     

吡格列酮对高血压合并糖耐量减低患者血压和胰岛功能的影响及其氧化应激机制

目的探讨吡格列酮对高血压合并糖耐量减低(IGT)患者血压、血糖和胰岛β细胞功能的影响及其氧化应激机制.方法160例高血压合并IGT患者随机分为两组,观察组(80例)和对照组(80例),另选取我院门诊查体的健康人60名作为健康对照组.吡格列酮治疗8周后比较治疗前后空腹血糖、餐后2小时血糖、血压、胰岛素分泌指数(Homa β)、胰岛素抵抗指数(Homa IR)、血清丙二醛和红细胞超氧化物歧化酶的变化.结果吡格列酮治疗8周后,空腹血糖、餐后2小时血糖、空腹胰岛素、餐后2小时胰岛素和糖化血红蛋白均较治疗前明显下降(P＜0.05);平均收缩压和平均舒张压均明显下降(P＜0.05);Homa β较治疗前明显升高(P＜0.05),而Homa IR较治疗前显著下降(P＜0.05);血清丙二醛水平较治疗前显著下降(P＜0.05),而血红细胞超氧化物歧化酶水平较治疗前明显升高(P＜0.05).结论吡格列酮可改善高血压合并IGT患者血压、血糖和胰岛β细胞功能,其机制涉及降低氧化应激.     

高血压患者胰岛素抵抗与血压昼夜模式改变的关系

目的 探讨原发性高血压时胰岛素抵抗(IR)与血压昼夜模式改变的关系.方法 对41例原发性高血压(EH组)、42例原发性高血压伴IR(EH+IR组)和30例健康志愿者(对照组)分别检测空腹血糖和胰岛素水平,计算胰岛素敏感指数(ISI),并行24小时动态血压监测,计算夜间血压下降率.结果 与EH组比较,EH+IR组血糖、胰岛素明显升高,ISI降低,收缩压及舒张压夜间下降率减少(P均<0.01).ISI与收缩压及舒张压夜间下降率呈负相关(r=0.645和-0.712,P<0.01).结论 IR与血压昼夜模式改变有关.     

肥胖患者运动性高血压的临床研究

目的 比较肥胖组与正常对照组运动负荷后的血压变化，探讨运动性高血压对肥胖患者高血压病早期诊断的临床意义。方法 观察静态及次极量踏车运动试验后血压变化，两组进行对比分析，并行24小时动态血压检查。结果 静态下两组血压无差异，运动后肥胖组血压超过标准者（42．86％）明显高于对照组（13．33％）；动态血压分析显示：肥胖组24小时及日间收缩压高于对照组，舒张压及夜间血压无显著差异。结论 肥胖患者运动性高血压患病率明显高于对照组，提示运动性高血压对肥胖者高血压病的早期诊断有一定参考价值。     

缬沙坦联合氨氯地平治疗社区老年原发高血压合并糖尿病的临床研究

目的观察分析缬沙坦联合氨氯地平治疗社区老年原发高血压合并糖尿病的临床效果。方法选取该院2018年1月—2019年2月收治的111例原发高血压合并糖尿病老年患者,按照数字随机表法分为实验组(55例)和对照组(56例)。采用统计学分析两组患者治疗前后的餐后2 h血糖水平、空腹血糖水平、血压(舒张压、收缩压)水平以及临床治疗总有效率。结果两组原发高血压合并糖尿病老年患者治疗前餐后2 h血糖水平、空腹血糖水平、血压(舒张压、收缩压)水平比较差异无统计学意义(P>0.05),治疗后实验组原发高血压合并糖尿病老年患者餐后2 h血糖水平、空腹血糖水平、血压(舒张压、收缩压)水平显著低于对照组(P<0.05);实验组的临床治疗总有效率显著高于对照组(P<0.05)。结论氨氯地平联合缬沙坦治疗社区老年原发高血压合并糖尿病的临床效果显著。     

福辛普利联合二甲双胍治疗高血压伴胰岛素抵抗的临床疗效观察:附43例报告

该文观察福辛普利联合二甲双胍治疗高血压伴胰岛素抵抗(insulin resistance,IR)患者的降压疗效和对胰岛素抵抗的影响。方法:将高血压伴IR的患者86例分为治疗组和对照组(各43例),前者给予福辛普利和二甲双胍治疗,后者单予福辛普利治疗,疗程均为3月。观察2组治疗前后血糖、胰岛素敏感指数、血压的变化及不良反应。结果:治疗组服药后空腹血糖、空腹胰岛素及餐后2h血糖均下降,胰岛素敏感指数升高,与对照组比较差异均有统计学意义(P<0.05~P<0.01)。2组服药后收缩压与舒张压均下降,但治疗组收缩压降压幅度较对照组大(P<0.01)。2组在治疗期间均…     

二甲双胍联合依那普利叶酸片治疗高血压伴糖耐量减低患者临床观察

目的探讨二甲双胍联合依那普利叶酸片治疗高血压伴糖耐量减低患者的临床效果。方法选取2015年1月至2018年3月我院内分泌科收治的高血压伴糖耐量减低患者68例作为研究对象,采用随机数字表法分为观察组和对照组,每组34例。对照组患者给予马来酸依那普利叶酸片治疗,观察组患者在对照组治疗的基础上,给予盐酸二甲双胍片治疗。两组患者均连续治疗24周。比较两组患者治疗前后的血糖、胰岛素、血脂、血压水平及降血压临床疗效。结果治疗前,两组患者的血糖、胰岛素、血脂、血压水平比较差异无统计学意义(P 0. 05)。治疗24周后,两组患者的空腹血糖(FPG)、餐后2h血糖(2hPG)、餐后2h胰岛素、总胆固醇(TC)、三酰甘油(TG)、收缩压(SBP)、舒张压(DBP)水平均显著下降,胰岛素敏感指数均显著上升;观察组患者的FPG、2hPG、餐后2h胰岛素、TC、TG、SBP、DBP水平显著低于对照组,胰岛素敏感指数高于对照组;观察组患者降血压治疗总有效率(97. 06%)显著高于对照组(85. 29%),差异有统计学意义(P 0. 05)。结论二甲双胍与依那普利叶酸片联合治疗高血压伴糖耐量减低患者临床效果显著,能够有效降低患者血压、血糖、血脂以及餐后2h胰岛素水平,提高机体组织对胰岛素的敏感性。     

2型糖尿病患者血浆Apelin-12水平与高血压、胰岛素抵抗的相关性

目的探讨Apelin-12与高血压、肥胖、胰岛素抵抗、炎症等的相关性。方法测定31例单纯2型糖尿病、37例2型糖尿病合并高血压患者及25例健康对照者血浆Apelin-12、肿瘤坏死因子α(TNF-α)、血脂、糖化血红蛋白(HbA1c)、空腹血糖、空腹胰岛素(FINS)、胰岛素抵抗(IR)指数(HOMA-IR)、体重指数(BMI)、血压等水平并进行各参数之间的相关分析。结果①糖尿病合并高血压组血浆Apelin-12水平低于正常对照组和单纯糖尿病组(P0.05或P0.01),单纯糖尿病组血浆Apelin-12水平高于正常对照组(P0.05)。②糖尿病合并高血压组TNF-α水平高于糖尿病组和正常对照组(P0.05或P0.01),糖尿病组TNF-α水平高于正常对照组(P0.05)③直线相关分析显示,空腹血浆Apelin-12与腰臀比(WHR),FINS,HOMA-IR,甘油三酯(TG),收缩压(SBP),TNF-α呈负相关,与HDL-C呈正相关。结论血浆Apelin-12水平在糖尿病组升高,在糖尿病合并高血压组降低,且与肥胖、IR、炎症等相关。推测Apelin-12可能参与了IR、2型糖尿病、高血压等疾病的发生发展。     

高血压病合并脂肪肝发病的危险因素分析

目的探讨高血压病合并脂肪肝发病的危险因素。方法选择进行了肝脏B超检查的住院高血压病患者,根据超声影像的诊断结果分为高血压合并脂肪肝组(98例)和高血压未合并脂肪肝组(102例),分析体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT)、胰岛素抵抗指数(HO-MA-IR)、糖耐量试验各时段的血糖水平、胰岛素释放试验的胰岛素水平与脂肪肝之间的关系。结果(1)Logistic回归分析的结果表明空腹血糖升高、肥胖、糖负荷后3小时胰岛素水平升高、高甘油三酯血症是高血压患者脂肪肝形成的独立危险因素;(2)高血压合并脂肪肝组的HOMA-IR、TG、空腹和糖负荷后2、3小时的血糖和胰岛素水平高于对照组(均P<0.05)。校正两组BMI后,上述差异仍然存在。结论(1)高血压病患者脂肪肝发病的独立危险因素是空腹血糖升高、肥胖、糖负荷后3小时胰岛素水平升高、高甘油三酯血症,随着这些危险因素的聚集,脂肪肝的检出率增加。(2)脂肪肝是高血压病患者胰岛素抵抗的“重要标志”,脂肪肝是代谢综合征的一种表现。     

Association between silent ST segment depression in exercise electrocardiography and insulin resistance in obese subjects

OBJECTIVES: This study was designed to clarify the association between ST segment depression in exercise electrocardiography (ECG) and insulin resistance in obese subjects. METHODS: A multistage graded submaximal exercise stress test on the bicycle ergometer was performed under CM5-lead ECG monitoring in 114 obese subjects (39 men and 75 women, mean age 50.9 +/- 12.2 years, mean body mass index 28.6 +/- 3.1 kg/m(2)). RESULTS: In 27 patients showing ST segment depression at the final exercise intensities (abnormal ST), insulin resistance index by homeostasis model assessment (HOMA-IR) was higher and insulin sensitivity index was lower than in the remaining 87 patients with normal ST segment level (normal ST). The abnormal ST group showed significantly higher plasma glucose and serum insulin levels during the oral glucose tolerance test (OGTT) than the normal ST group. The abnormal ST group showed a significantly higher prevalence of hypertension, impaired glucose tolerance and metabolic syndrome than the normal ST group. Multiple logistic regression analysis showed that insulin resistance as evaluated by fasting insulin, sigma insulin during OGTT, HOMA-IR, insulin sensitivity index, the levels of uric acid, fasting glucose, systolic blood pressure and maximal oxygen uptake were independently associated with ST segment depression. CONCLUSIONS: These results suggest that insulin resistance may involve pathological ST depression during exercise, as well as previously reported factors such as hyperglycemia, hyperuricemia, hypertension and lower aerobic capacity.     

体育运动对轻度高血压病患者血胰岛素的影响

目的探讨体育运动对高血压病患者血胰岛素的影响。方法将１０９例轻度原发性高血压病患者随机分配到运动组（５３例）和对照组（５６例）。两组均接受尼群地平降压治疗，同时对运动组进行为期３个月的中等强度运动干预。测量两组入选时和３个月后血压、空腹血糖、血胰岛素、血脂及口服葡萄糖负荷后１、２小时血糖及胰岛素。结果经过３个月规则运动，运动组空腹及糖负荷后１、２小时胰岛素水平低于对照组（Ｐ值均＜００５），其空腹胰岛素下降程度与运动量呈正相关（ｒ＝０６１，Ｐ＜００５），血胆固醇、甘油三酯及低密度脂蛋白水平低于对照组（Ｐ＜００５）。结论长期中等强度的体育运动能降低高血压病患者空腹及糖负荷后血胰岛素水平，并有利于纠正血脂代谢紊乱。     

Associations between plasma insulin and high blood pressure]

We studied the relationship between plasma insulin level and hypertension in 510 cases with normal glucose tolerance and impaired glucose tolerance. In nonobese group (BMI < 25kg/m2), plasma insulin was higher in those with hypertension than those with normal blood pressure (P < 0.0001). There was no correlation between diastole blood pressure and plasma insulin; multiple regression analysis showed that fasting plasma insulin was significantly associated with systolic blood pressure after controlling age, BMI and plasma glucose level (beta = 0.27, P = 0.0078). The result suggested that age, BMI and plasma insulin level were independent risk factors of hypertension. In obese group (BMI > 25kg/m2), blood pressure was significantly associated with age and BMI, there was no association between blood pressure and plasma insulin level.     

The association of brain natriuretic peptide and insulin resistance in obesity-related hypertension

Hypertension is frequently associated with obesity and natriuretic peptide levels are reported to decrease in obese subjects. Both the lower brain natriuretic peptide (BNP) concentration and insulin resistance are suggested to be associated with hypertension. However, their involvement in obesity-related hypertension has not been clearly defined. Forty-four obese women (21 normotensive and 23 hypertensive) and 25 healthy women matched for age were included in the study. Anthropometrical parameters were determined. Serum BNP, fasting insulin and glucose concentrations, and lipid parameters were evaluated. Insulin resistance was calculated using Homeostasis Model Assessment (HOMA) and Quantative Insulin Sensitivity Check Index (QUICKI) formulations. Within the obese groups, HOMA and QUICKI reflected the increased insulin resistance in hypertensive obese subjects with a significant correlation to blood pressure. The decrease in BNP in the obese groups was in favour of the hypertensive obese subjects (31.43+/-6.43; 26.36+/-4.29; and 17.51+/-3.08 pg/ml, respectively) with a fractional statistical significance between the hypertensive obese group and the controls (P=0.047). Only for the obese hypertensive group, fasting glucose, HOMA and QUICKI were significantly correlated with BNP. Moreover, fasting plasma glucose (R(2)=0.22, P=0.007) and fasting plasma insulin (R(2)=0.39, P=0.03) were independently correlated with BNP only for the obese hypertensive group. It can be concluded that the decrease in BNP concentrations in the obese hypertensive subjects seem to be well correlated with the insulin resistance.     

Responses of serum insulin and blood pressure to cold and handgrip in obese patients.

A close correlation between body weight and blood pressure has been frequently observed in both clinical and epidemiological studies. The aim of this clinical trial was to evaluate whether, in obese patients, there is any relationship between blood pressure, at rest or during sympathetic stimulation, and blood glucose and serum insulin, both while fasting and during an oral glucose challenge. Twenty obese patients (age 26-65 years, body weight 97 +/- 16 kg, 11 normotensive and 9 hypertensive) entered the study. After a 4-week run-in period on an isocaloric diet with normal intake of sodium, blood pressure and heart rate were measured at rest and during sympathetic stimulation induced by cold and isometric testing. Responses of glucose and insulin to a standardized 75 g oral glucose tolerance test were also evaluated. The responses of glucose and insulin to glucose challenge were not statistically different in normotensive and hypertensive obese patients. Levels of insulin in the serum in the serum in the fasting state and during glucose load were significantly correlated with the response of blood pressure to cold and isometric exercise, but not to blood pressure at rest. The response of heart rate to cold was closely related to insulin only in the subgroup of normotensives. The present findings support the hypothesis that the sympathetic nervous system, which influences secretion of insulin and regulation of blood pressure, is involved in the pathophysiology of the association of obesity and hypertension.     

A close association between insulin resistance and dehydroepiandrosterone sulfate in subjects with essential hypertension

To examine the serum levels of dehydroepiandrosterone sulfate (DHEAS) and its relation with insulin resistance and the other risk factors in essential hypertension, serum DHEAS and insulin sensitivity were assessed in 35 male hypertensive and 17 male healthy control subjects aged 50-59 years. Fasting plasma insulin and the area under curve of plasma insulin were determined during a 75 g oral glucose tolerance test. Insulin sensitivity was measured by the steady state plasma glucose method. Fasting plasma insulin and the area under curve of plasma insulin were significantly higher in the hypertensive group than in control group. Steady state plasma glucose was significantly higher in hypertensive subjects indicating insulin resistance compared with control subjects. On the other hand, fasting serum DHEAS levels were significantly lower in the hypertensive group than in the control group. Fasting serum DHEAS levels were inversely correlated with steady state plasma glucose significantly (p=0.0008), indicating a close association between DHEAS levels and insulin resistance. Fasting serum DHEAS was inversely correlated with systolic blood pressure and fasting plasma insulin. In multiple regression analysis of hypertensive subjects, steady state plasma glucose was the strongest determinant of the fasting serum level of DHEAS, followed by systolic blood pressure and fasting plasma insulin. These 3 factors accounted for 51.6% of the variation in DHEAS. In nonobese and nondiabetic essential hypertension, serum DHEAS was lower and insulin resistance was the most significant independent determinant of reduced serum DHEAS, followed by systolic blood pressure and fasting plasma insulin.     

Systolic blood pressure response to exercise in type 1 diabetes families compared with healthy control individuals

OBJECTIVE: Oxidative stress is increased in type 1 diabetes families. Since oxidative damage is a mediator of vascular injury and familial predisposition to hypertension increases the risk of hypertension and diabetic nephropathy, we studied blood pressure responses to exercise and cardiovascular risk factors in type 1 diabetes families. METHODS: Thirty-five type 1 patients, 74 first-degree relatives, and 95 healthy individuals without established coronary heart disease underwent a cycle ergometer test. Examination included medical history, lifestyle questionnaire, body weight, blood pressure, and laboratory tests [fasting plasma glucose and insulin, haemoglobin A1c (HbA1c), plasma lipids, C-reactive protein, fibrinogen, folate, plasma thiols, and albumin excretion rate]. RESULTS: Diabetic patients had higher plasma glucose, HbA1c, folate, and albuminuria, while lower plasma thiols than controls; relatives differed from controls in higher plasma total cholesterol and albuminuria, lower plasma thiols. No patient presented exercised-induced angina. Diabetic patients achieved a higher maximal exercise systolic blood pressure (similar workload); systolic pressure remained high during recovery. Relatives showed higher values of systolic pressure at peak exercise (same workload). The following were associated with an abnormal blood pressure response to exercise: diastolic blood pressure and HbA1c in the control sample; disease duration and fibrinogen in the diabetic group; plasma low-density lipoprotein (LDL) cholesterol, body mass index (BMI), housework, and plasma thiols among relatives. CONCLUSION: An abnormal blood pressure response to exercise testing has been identified for the first time in asymptomatic normotensive non-diabetic relatives of type 1 diabetics, which was associated with indices of metabolic syndrome and oxidative damage. Moreover, in healthy normotensive non-diabetic control individuals (without a family history of type 1 diabetes), the systolic blood pressure response to exercise was significantly correlated with HbA1c levels.     

老年阻塞性睡眠呼吸暂停综合征与高血压及胰岛素抵抗的相关性研究

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)与高血压及胰岛素抵抗(IR)的关系。方法随机选择符合OSAS患者48例作为OSAS组,并分为高血压组(28例)和正常血压组(20例)2个亚组,同期选择无OSAS的高血压患者30例作为单纯高血压组,健康体检者26例作为正常对照组,均进行整夜睡眠呼吸监测(7 h),并记录睡眠呼吸暂停低通气指数(AHI)等;空腹血糖(FPG)及空腹胰岛素(FINS)测定,对患者进行24 h的动态血压监测并进行相关分析。结果与单纯高血压组比较,高血压组患者非杓形血压比例和脉压均明显升高,差异有统计学意义(P0.05,P0.01)。OSAS组患者的FPG、FINS水平及胰岛素抵抗指数(HOMA-IR)均明显高于正常对照组,差异有统计学意义(P0.05);OSAS患者的AHI与FINS和HOMA-IR均呈正相关。结论 OSAS与IR存在独立的相关性,可能通过IR导致并进一步加重心血管疾病的发生和发展。     

Insulin resistance and abnormal electrocardiograms in patients with high blood pressure.

Plasma glucose and insulin responses to an oral glucose challenge and fasting plasma lipid and lipoprotein concentration were compared in 25 normal individuals and 53 patients with high blood pressure. Patients with hypertension were further subdivided into two groups--normal electrocardiogram (EKG) (n = 24) or abnormal EKG (n = 29)--using the Minnesota code criteria. Patients with hypertension and an abnormal EKG had significantly higher plasma glucose and insulin concentrations following oral glucose than did the control population. Furthermore, plasma triglyceride (TG) concentration was higher and high density lipoprotein cholesterol concentration lower then normal in hypertensive patients with an abnormal EKG, and the ratio of total to HDL cholesterol was higher in this subgroup. Values for patients with high blood pressure and a normal EKG were intermediate. Insulin-mediated glucose uptake was also measured in a subset of patients with hypertension and either a normal (n = 18) or abnormal (n = 17) EKG. When these two subgroups were compared, those with high blood pressure and an abnormal EKG were significantly more insulin resistant than patients with hypertension and a normal EKG. In addition, they also had higher plasma glucose and insulin responses to oral glucose, higher fasting plasma triglyceride and cholesterol concentrations, and an increase in the ratio of total to HDL cholesterol. Thus, patients with high blood pressure have abnormalities of glucose, insulin, and lipid metabolism when compared to a nonhypertensive control group, and the magnitude of these metabolic defects is significantly greater in patients with high blood pressure who have EKG evidence of coronary heart disease.