肥胖伴血压晨峰患者血清中期因子水平与胰岛素抵抗的关系

摘要

Objective To investigate the relationship between serum midkine ( MK ) level and insulin resistance in obesity patients with morning blood pressure surge (MBPS). Methods Based on the results of 24 hours ambulatory blood pressure monitoring and body mass index( BMI),150 subjects with normal clinic blood pressure were divided into three groups, obesity with MBPS ( BMI≥25 kg/m2,MBPS≥35 mmHg) group ( n=42),single obesity ( BMI≥25 kg/m2,MBPS<35 mmHg)group (n=58) and healthy control (BMI<25 kg/m2, MBPS<35 mmHg) group (n=50) . The level of serum MK was detected by ELISA method. The fasting plasma glucose and fasting insulin were also detected. The insulin resistance was assessed by insulin resistance index ( HOMA￣IR) which was calculated by homeostasis model assessment. The levels of three groups′ serum MK were compared and the correlation of serum MK level and HOMA￣IR was analysed. Results ①The comparision of serum MK level showed:the serum MK level in obesity with MBPS group was signifi￣cantly higher compared with that in healthy control group and in single obesity group [(1�44±0�32) vs (0�86±0�11),(0�90±0�15) all P<0�01]. There was no significant difference in serum MK be￣tween single obesity group and healthy control group� ②The comparision of HOMA￣IR showed:HOMA￣IR in MBPS group was significantly higher compared with that in healthy control group and single obesity group [(5�23±0�96) vs(1�81±0�21), (2�72±0�37) all P<0�01]. HOMA￣IR in single obesity group was higher than that in healthy control group ( P<0�05) . ③Pearson correlation analysis indicated that the serum MK level was positively correlated with HOMA￣IR in MBPS group ( r=0�494,P<0�01 ) . Conclusion There was hyperinsulinemia and the level of serum MK was correlated with HOMA￣IR in obesity patients. MK and insulin resistance may be involved in the occurrence and development of MBPS in obesity patients.%目的：探讨肥胖伴血压晨峰( morning blood pressure surge，MBPS)患者血清中期因子( midkine，MK)与胰岛素抵抗的关系。方法选择诊所血压正常的肥胖者100例和体质量正常的健康体检者47例(对照组)，均行24 h动态血压监测，按MBPS结果肥胖患者分为血压晨峰组(MBPS≥35 mmHg)42例和单纯肥胖组(MBPS<35 mmHg)58例。采用酶联免疫吸附法检测外周血清MK含量，并测定空腹血糖(fasting plasma glucose，FPG)、血浆胰岛素水平，采用稳态模式评估法计算胰岛素抵抗指数( homeostasis model assessment￣insu￣lin resistence index，HOMA￣IR)来评价胰岛素抵抗，同时分析血压晨峰组患者MK水平与HOMA￣IR的相关性。结果①MK：与对照组和单纯肥胖组比较，血压晨峰组的血清MK明显升高[(0�86±0�11)、(0�90±0�15)比(1�44±0�32)，P均<0�01]；单纯肥胖组与对照组比较差异无统计学意义。②HOMA￣IR水平比较：血压晨峰组(5�23±0�96)高于单纯肥胖组(2�72±0�37)和对照组(1�81±0�21)，差异有统计学意义(P均<0�01)；单纯肥胖组高于对照组，差异有统计学意义( P<0�05)。③Pearson相关分析显示，血压晨峰组MK水平与HOMA￣IR呈正相关( r＝0�494，P<0�01)。结论肥胖患者存在高胰岛素血症，合并血压晨峰的肥胖患者随着胰岛素抵抗程度的加重MK水平升高。胰岛素抵抗与血清MK可能共同参与了肥胖合并MBPS的发病。