CAJ | 학술논문

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。
목적：탐토비반반혈압신봉( morning blood pressure surge，MBPS)환자혈청중기인자( midkine，MK)여이도소저항적관계。방법선택진소혈압정상적비반자100례화체질량정상적건강체검자47례(대조조)，균행24 h동태혈압감측，안MBPS결과비반환자분위혈압신봉조(MBPS≥35 mmHg)42례화단순비반조(MBPS<35 mmHg)58례。채용매련면역흡부법검측외주혈청MK함량，병측정공복혈당(fasting plasma glucose，FPG)、혈장이도소수평，채용은태모식평고법계산이도소저항지수( homeostasis model assessment￣insu￣lin resistence index，HOMA￣IR)래평개이도소저항，동시분석혈압신봉조환자MK수평여HOMA￣IR적상관성。결과①MK：여대조조화단순비반조비교，혈압신봉조적혈청MK명현승고[(0?86±0?11)、(0?90±0?15)비(1?44±0?32)，P균<0?01]；단순비반조여대조조비교차이무통계학의의。②HOMA￣IR수평비교：혈압신봉조(5?23±0?96)고우단순비반조(2?72±0?37)화대조조(1?81±0?21)，차이유통계학의의(P균<0?01)；단순비반조고우대조조，차이유통계학의의( P<0?05)。③Pearson상관분석현시，혈압신봉조MK수평여HOMA￣IR정정상관( r＝0?494，P<0?01)。결론비반환자존재고이도소혈증，합병혈압신봉적비반환자수착이도소저항정도적가중MK수평승고。이도소저항여혈청MK가능공동삼여료비반합병MBPS적발병。
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 <br> occurrence and development of MBPS in obesity patients.