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目的探讨原发性高血压(EH)有、无胰岛素抵抗(IR)患者左室重构及舒张功能的变化。方法测定86例EH患者和45例体检健康者空腹血糖及胰岛素,并计算胰岛素敏感性指数(IAI),以≤对照组IAI均值(-3.72±0.32)的低限(-4.04)者46例作为IR组,非IR组40例。比较三组受试者心脏舒张功能指标:等容舒张时间(IVRT)、二尖瓣环舒张早期运动速度(Ea)/舒张晚期运动速度(Aa)比值;左室重构指标:血清前胶原羧基端肽(PIP)、金属蛋白酶-2(MMP-2)浓度。结果与对照组比较非IR组和IR组平均IVRT均明显延长、Ea/Aa比值均明显降低、血清PIP、MMP-2均显著升高(P<0.05和P<0.01);且与非IR组比较IR组平均IVRT和血清PIP、MMP-2进一步显著延长和升高,Ea/Aa比值进一步显著降低(P<0.05和P<0.01)。结论伴有IR的高血压患者较非IR高血压患者左室心肌重构更重、左室舒张功能更差。
Objective To investigate the changes of left ventricular remodeling and diastolic function in patients with essential hypertension (EH) and without insulin resistance (IR). Methods The fasting blood glucose and insulin in 86 EH patients and 45 healthy volunteers were measured and the insulin sensitivity index (IAI) was calculated. Forty-six patients (≤ -4.04) with ≤ IAI in the control group (-3.72 ± 0.32) IR group, non-IR group of 40 cases. The indexes of diastolic function (IVRT), early diastolic velocity (Ea) / late diastolic velocity (Aa) were compared between the three groups. Left ventricular remodeling index Telopeptide (PIP), metalloproteinase-2 (MMP-2) concentrations. Results Compared with the control group, the average IVRT of non-IR group and IR group were significantly prolonged, the Ea / Aa ratio was significantly lower, serum PIP, MMP-2 levels were significantly increased (P <0.05 and P <0.01) The mean IVRT, serum PIP and MMP-2 in IR group were significantly longer and higher, and the ratio of Ea / Aa was significantly lower (P <0.05 and P <0.01). Conclusion Compared with non-IR hypertensive patients, IR patients with hypertension have more severe left ventricular remodeling and worse left ventricular diastolic function.