【作者】 常彩云；

【导师】 王束玫；

【作者基本信息】 山东大学 ， 流行病与卫生统计学， 2007， 硕士

【摘要】 研究背景：随着对脂肪组织研究的深入进展，人们发现脂肪组织不仅是一个能量储存器官，更是一个高度活跃的内分泌器官，它可以分泌一系列可溶性的细胞因子，包括肿瘤坏死因子(TNP)-α、瘦素(1eptin)、脂联素(adiponectin)、抵抗素(resistin)、纤溶酶原激活抑制因子(PAI)-1等。脂联素是脂肪组织特异性分泌的激素，其水平在肥胖、胰岛素抵抗、糖尿病、动脉粥样硬化等患者体内均显著降低。研究表明，脂联素能减少肝脏葡萄糖输出，增加脂肪酸氧化，改善胰岛素抵抗，具有抗炎、抗动脉粥样硬化等作用。人们对脂联素水平的研究多集中于肥胖、糖尿病等疾病中，而对高血压患者体内脂联素水平的研究在国内外均较少，且研究结果不具有一致性。Mallamaci等报道伴有肾功能损伤的高血压患者体内脂联素水平明显升高，而Adamczak等的研究表明高血压患者体内脂联素水平较正常组显著降低。Maruyoshi Y等认为低脂联素血症是影响高血压的独立危险因素，而Furuhashi研究表明只有伴胰岛素抵抗的高血压患者体内脂联素水平才降低。与此同时，研究表明近40％的高血压患者均存在胰岛素抵抗，胰岛素抵抗能促进高血压的发生与发展。因此，高血压患者体内的低脂联素水平是血压本身升高所致还是高血压的伴随状态即胰岛素抵抗所致目前尚未明确，需进一步的研究探讨。研究目的：通过对高血压患者体内脂联素水平的检测，进而弄清脂联素水平的下降是伴随胰岛素抵抗进行还是作为高血压的独立影响因素出现，不仅为高血压的发生机制提供依据，还能为高血压患者的治疗乃至代谢综合征这一类疾病的治疗提供依据。研究方法：选取180例新诊断的高血压患者及180例血压正常者，用放射免疫法测定血清中胰岛素水平，同时测定身高、体重、收缩压、舒张压、空腹血糖、血脂等相关指标的水平，探讨高血压与胰岛素抵抗间的关系。随后选取近三个月未曾服用任何可影响血压、血糖、脂联素及血脂等药物的170名研究对象，其中男性98例，女性82例。高血压伴胰岛素抵抗者(EHT-R)41例，高血压不伴胰岛素抵抗者(EHT-N)47例，正常血压伴胰岛素抵抗者(NT-R)41例，正常血压不伴胰岛素抵抗者(NT-N)41例。用酶联免疫分析法测定血清脂联素水平，运用协方差分析法比较四组对象中血清脂联素的浓度。主要研究结果：1．高血压患者中男性所占的比例明显高于女性，年龄、性别、体重指数(BMI)及胰岛素抵抗指数是高血压的主要影响因素。2．所有研究对象中，血清脂联素水平在四组间差异无统计学意义(F=2.154，P=0.096)。3．对男性四组资料的脂联素水平进行两两比较，结果发现，正常血压不伴胰岛素抵抗组(NT-N)的脂联素水平显著高于高血压伴胰岛素抵抗组(EHT-R)、高血压不伴胰岛素抵抗组(EHT-N)、正常血压伴胰岛素抵抗组(NT-R)三组。通过高血压及胰岛素抵抗对脂联素的交互作用进行分析，结果显示未发现交互作用存在(F=3.457，P=0.066)。这提示我们，高血压、胰岛素抵抗分别与血清脂联素水平独立相关。4．女性血清脂联素水平在四组间差异无统计学意义(F=0.818，P=0.489)，正常血压不伴胰岛素抵抗组(NT-N)的血清脂联素水平最低。结论：年龄、性别、体重指数(BMI)及胰岛素抵抗指数是影响高血压的重要因素；在170例研究对象中，未发现血清脂联素水平与高血压、胰岛素抵抗的相关性；而在男性研究对象中，高血压、胰岛素抵抗均与血清低脂联素水平独立相关。创新：本文讨论中大胆推测高血压、胰岛素抵抗与血清脂联素水平独立相关，脂联素可能是联系高血压及胰岛素抵抗的关键因素。更多还原

【Abstract】 Background: Adipose tissue was once thought to be simply a depot for fuel storage in the form of triglyceride. However, it is now known that adipocytes secretes many biologically active molecules such as tumor necrosis factor-α, leptin, adiponectin, resistance and plasminogen-activator inhibitor type 1. Adiponectin is one of the key molecules in the metabolic syndrome, and its concentration is decreased in obesity, insulin resistance, type- II diabetes, and coronary artery disease. Adiponectin can reduce triglyceride accumulation in skeletal muscle; enhance insulin sensitivity; modulate the endothelial inflammatory response and prevent atherosclerosis. Even though an association between hypertension and serum adiponectin concentration has been reported by several groups using a small number of subjects, the results are inconsistent. Mallamaci et al reported an increased plasma adiponectin concentration in hypertensive patients with renal dysfunction, but Adamczak et al reported decreased adiponectin in hypertensive subjects. Maruyoshi Y showed that hypoadiponectinemia is an independent risk factor. Furuhashi et al reported that only hypertensive patients with insulin resistance showed lower adiponectin concentration. It has been shown that approximately 40% of essential hypertension is insulin resistance. Insulin resistance and accompanying hyperinsulinemia have been linked to the onset and progression of hypertension and atherosclerosis.But the hypoadiponectinemia in hypertension patients is the result of an increase in blood pressure itself or the accompanying condition insulin resistance was not clear. So we designed a study to investigate the association of hypoadiponectinemia, hypertension and insulin resistance. Objective: Plasma adiponectin concentrations in the four groups were compared in order to investigate the association of adiponectin concentration with hypertension and insulin resistance.Methods: A total of 180 diagnosed cases of essential hypertension (EHT) and 180 normotensive subjects (NT) were enrolled in this study to test the relationship of hypertension and insulin resistance. Then we selected total 170 subjets which had been taking no medicine or had stopped taking all drugs that may affect blood pressure, insulin, glucose, blood fat value at least 3 months before the start of the study. There were 41 essential hypertensive patients with insulin resistance (EHT-R), 47 essential hypertensive patients without insulin resistance (EHT-N), 41 normotensive subjects with insulin resistance (NT-R) and 41 normotensive subjects without insulin resistance (NT-N) were enrolled in our research. Plasma adiponectin concentrations in the four groups were compared in order to approach the association of adiponectin concentration with hypertension and insulin resistance.Results:1. The proportion of hypertension in female subjects was lower than male subjects. Multiple regression analysis revealed that age, sex, BMI, and HOMA-IR independently affected the risk for hypertension of the total subjects.2. In the 170 subjects, there was no significantly difference of adiponectin concentration in the four groups.3. Adiponectin concentrations in NT-R male group were lower than that of NT-N male group; in EHT-N male group, the adiponectin concentrations decreased compared to NT-N male subjects. No interaction was detected significantly between the insulin resistance and hypertension to adiponectin concentration after adjustment for BMI and HDL-C value.4. In the female subjects, there was no significantly difference of adiponectin concentration in the four groups (F=0.818, P=0.489). The adiponectin concentrations in NT-N female groups were lowest.Conclusion: The results demonstrated that age, sex, BMI, and HOMA-IR independently affected the risk for hypertension of the subjects; insulin resistance and hypertension were independent factors for hypoadiponectinemia in the male subjects.Innovation: In our study, we revealed that insulin resistance and hypertension were independent factors for hypoadiponectinemia, adiponectin maybe the key factor which connected the insulin resisitance and hypertension.更多还原