血管紧张素Ⅱ与高血压及其代谢性危险因素的关系
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摘要
研究背景
高血压的发生通常合并多种代谢异常,目前国内外鲜见血管紧素II（AngⅡ）与高血压代谢性危险因素的关系的报道且尚未定论。
研究目的
探讨蒙古族人群中AngⅡ与高血压及其代谢性危险因素（高血糖、胰岛素抵抗、超重与肥胖、血脂异常）之间的关系。为以后治疗肥胖性高血压这类合并性高血压时提供一个以AngⅡ为靶点的新思路。
研究方法
以2589例年龄在20岁及以上并排除已知的脑卒中、冠心病和肾脏病患者的蒙古族常住居民为研究对象，采用横断面调查的方法，调查收集人口统计学、病史相关资料和生活方式危险因素资料，测量血压、身高、体重、腰围，并现场采集血标本低温保存运回实验室检测总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、血糖、胰岛素和Ang II等指标。双人双遍录入Epidata数据库，采用软件SPSS16.0进行统计分析。比较Ang II正常组和Ang II升高组的基本人口学特征和各项高血压代谢性危险因素的差异，运用单因素和多因素Logistic回归模型分别分析不同Ang II水平与高血压及其代谢性危险因素（高血糖、胰岛素抵抗、超重与肥胖、血脂异常）之间的关系，计算比值比（odds ratio，OR）和95%可信区间，并作趋势性检验。
研究结果
1.在纳入研究的2559名研究对象中，按照AngⅡ的上四分位点分组后，AngⅡ正常组有1919人，AngⅡ升高组共640人。AngⅡ升高组的男性、吸烟、饮酒者和心血管疾病家族史的比例以及血压、血糖、胰岛素、血脂中甘油三酯的平均水平均高于Ang II正常组，差异有统计学意义（P<0.05）。而两组比较，年龄、体质指数、腰围以及血脂中的胆固醇、低密度脂蛋白、高密度脂蛋白的平均水平的差异不具有显著性（P>0.05）。
2. AngⅡ正常组的高血压、胰岛素抵抗、超重、中心性肥胖和高甘油三脂的患病率分别为34.5%、23.7%、27.1%、41.3%和8.9%；而AngⅡ升高组这些代谢性危险因素的患病率依次分别为46.0%、28.5%、26.8%、41.6%和14.4%；其中，高血压、胰岛素抵抗和高甘油三酯这三个指标在两组的患病率差异有统计学意义（P<0.05），而超重和中心性肥胖两者差异无统计学意义（P>0.05）。
3.根据不同代谢性危险因素分组后，两组AngⅡ水平比较显示：高血压患者、胰岛素抵抗患者、高甘油三脂患者相对于正常组拥有一个更高的AngⅡ水平（52.0vs47.0pg/ml；48.0vs51.9；57.8vs48pg/ml），差异均有统计学意义（P<0.001）；而其他代谢性危险因素包括空腹血糖受损、肥胖、血脂异常中的高胆固醇、低高密度脂蛋白、高低密度脂蛋白的患者和正常人群中AngⅡ水平的分布差异无统计学意义（P>0.05）
4.不同AngⅡ水平下，收缩压和舒张压多因素调整后的协方差分析与趋势性检验结果都有统计学意义（P<0.05），经多因素调整后，相对于AngⅡ的最低分位，AngⅡ最高分位高血压前期的危险性上升至1.52倍；高血压的危险上升至1.95倍，均P<0.05。
5.无论是单因素还是多因素Logisitic回归，AngⅡ最高分位高血糖危险性的OR值和趋势性检验都无统计学意义，P>0.05。但计算不同AngⅡ水平胰岛素增高的危险性结果显示：调整了性别、血压、血糖、血脂后，Ang II水平＞71.3pg/ml组出现胰岛素增高危险性的OR值为1.71，可信区间为1.31-2.23。经趋势性检验，Ang II水平与胰岛素增高的OR值之间存在剂量反应关系，均P<0.05。
6.调整了多因素后，与AngⅡ≤40.0pg/ml者比较，AngⅡ在40.0～49.0pg/ml、49.0～71.3pg/ml、＞71.3pg/ml的研究对象胰岛素抵抗的OR值（95%CI）分别为1.17（0.90,1.57）；1.33（1.03,1.71）和1.43(1.10,1.85)。趋势性检验结果显示，随着AngⅡ水平的增加研究对象胰岛素抵抗的危险性增加，P<0.05。
7.调整了年龄、性别、吸烟、饮酒、血压、血糖、胰岛素、TC、TG、HDL-C、LDL-C后，未发现AngⅡ与超重和中心性肥胖的关联，P>0.05。
8.不同AngⅡ水平下，研究对象患血脂异常的危险性并没有随AngⅡ水平的增加而增加。我们试探性的研究不同血脂异常情况下指标水平与AngⅡ升高的关联性，结果显示：不管是单因素还是多因素Logisitic回归分析，高TC、高LDL-C和低HDL-C与研究对象中AngⅡ升高的关联都无统计学意义，P>0.05。但是对于高TG，调整年龄、性别、吸烟、饮酒、血压、血糖、胰岛素、BMI、腰围后，高TG患者AngⅡ升高的危险性是正常人群的1.51倍，趋势性检验结果显示，随着TG水平的增加，AngⅡ升高的可能性就越大，P<0.05。
结论
1..高血压患者、胰岛素抵抗患者、高甘油三脂患者中Ang II浓度高于正常人群，Ang II增高与高血压、胰岛素抵抗和高甘油三酯有关联。
2.对于该研究人群，未发现AngⅡ与糖尿病、超重与肥胖和血脂异常中高胆固醇、低-高密度脂蛋白和高-低密度脂蛋白的关联。
Background
The incidence of hypertension is often accompanied with a variety of metabolicabnormalities. Currently, relationships between Angiotensin II (Ang II) and metabolicrisk factors of hypertension are rarely reported and not yet conclusive both at home andabroad.
Purpose
This thesis is aimed at exploring the relationships between Ang II and hypertensionas well as its metabolic risk factors (high blood glucose, insulin resistance, overweightand obesity, dyslipidemia) in Mongolian; The results can provide a new way oftargeting Ang II for the future treatment of combined hypertension, such as obesity.
method
2559Mongolian ordinarily residents aged20years and above were studied, andknown patients of stroke, coronary heart disease, and kidney patients were excluded.Using cross-sectional survey, data on demographic characteristics, history of diseasesand lifeway risk factors were collected and blood pressure, height and weight, waistcircumference were measured.The blood samples were collected in site and werecryopreserved and transported to the laboratory for detection of cholesterol,triglycerides, high-density lipoprotein, low-density lipoprotein, glucose, insulin,Ang IIand other indicators. The indicators were recorded into Epidata database double timesby two persons, and analyzed by SPSS16.0software. The differences of demographiccharacteristics and metabolic risk factors of hypertension between the normal Ang IIgroup and the increased Ang II group were compared,and the relationships betweendifferent Ang II levels and hypertension as well as its metabolic risk factors (highblood glucose, insulin resistance, overweight and obesity, dyslipidemia) were analyzed by using single and multiple logistic regression model; odds ratios (ORs),95%confidence interval (95%CI) and the trend test were calculated.
Results
1. The2589subjects in the study were grouped in accordance with AngII quartile,and there are1919subjects in the normal Ang II group while640in the increased AngII group. In the increased Ang II group, the proportions of male, smoking and drinking,and family history of cardiovascular disease was higher than the normal group, so werethe levels of blood pressure, blood glucose, insulin, triglycerides of lipids, thedifferences were statistically significant (P<0.05). However, in the two groups,differences in age, body mass index, waist circumference and cholesterol, low-densitylipoprotein, high density lipoprotein were not statistically significant (P>0.05).
2. The prevalences of hypertension, insulin resistance, overweight, central obesityand high triglycerides were34.5%,23.7%,27.1%,41.3%and8.9%in the normal AngIIgroup,respectively. The corresponding prevalences were46.0%,28.5%,26.8%,41.6%and14.4%in the AngII increased group.The differences in prevalences of high bloodpressure, insulin resistance, and high triglyceride were statistically significant betweenthe two group (P<0.05), but differences in overweight and central obesity were notstatistically significant (P>0.05).
3. Being grouped according to the different risk factors, the Ang II level wascompared: patients with high blood pressure, insulin resistance and high triglycerideshad a higher level of Ang II relative to the normal group (52.0vs47.0pg/ml;48.0vs51.9;57.8vs48pg/ml), and the differences were statistically significant (P <0.001);but distribution of Ang II level in patients with other metabolic risk factors such asimpaired fasting plasma glucose, obesity, dyslipidemia, high cholesterol, low HDL orhigh LDL was not statistically significant (P>0.05).
4. For different Ang II levels, adjusted covariance analysis and trend test resultswere statistically significant of systolic and diastolic pressure (P<0.05). Aftermultivariate adjustment, compared to the lowest AngII quintile, the prehypertension riskof the highest quintile rose to1.52times; the risk of hypertension rose to1.95times,both P <0.05.
5. After logisitic regression, whether single factor or multi-factor, the OR value andthe trend test of the risk of high blood glucose were not statistically significant, P>0.05. However, results of the risk of increased insulin with different Ang II levels showed that,after adjusting for sex, blood pressure, blood sugar and blood lipids, the OR value ofinsulin increased risk in the Ang II>71.3pg/ml group was1.71, and the confidenceinterval was1.31-2.23. By the trend test, dose-response relationship was existedbetween Ang II levels and OR value of increased insulin, both P <0.05.
6. After adjusting for the multi-factor, compared with Ang II≤40.0pg/ml, the ORvalues(95%CI) of insulin resistance for objects with Ang II in40.0~49.0pg/ml,49.0~71.3pg/ml,>71.3pg/ml were1.17(0.90,1.57),1.33(1.03,1.71) and1.43(1.10,1.85),respectively. The trend test results showed that risk of insulin resistance wasincreased with AngII levels increasing, P <0.05.
7. After adjusting for age, sex, smoking, alcohol consumption, blood pressure,blood glucose, insulin, TC, TG, HDL-C, LDL-C, Ang II was not found associated withoverweight and central obesity, P>0.05.
8. For different Ang II levels, risk of suffering from dyslipidemia was did notincrease with the Ang II levels increased. We caculated the association of differentdyslipidemia and increasing Ang II, the results showed: whether single or multiplelogistic regression analysis,the relationships of Ang II and high TC, high LDL-C andlow HDL-C were not statistically significant (P>0.05). But for high TG, after adjustingfor age, sex, smoking, alcohol consumption, blood pressure, blood glucose, insulin,BMI and waist circumference, the risk of increased Ang II is1.51times higher than thenormal TG. The results of trend test showed that the Ang II levels increased as TG levelsincreased, P <0.05.
Conclusion
1. Ang II levels were higher participants with hypertension,insulin resistance,hightriglycerides than those in the normal population, increased Ang II level is a risk factorof hypertension, insulin resistance and high triglycerides.
2.The significant relationships between Ang II and diabetes, overweight andobesity, high cholesterol, low-high density lipoprotein and high-low density lipoproteinwere not found among study population.
高血压的发生通常合并多种代谢异常,目前国内外鲜见血管紧素II（AngⅡ）与高血压代谢性危险因素的关系的报道且尚未定论。
研究目的
探讨蒙古族人群中AngⅡ与高血压及其代谢性危险因素（高血糖、胰岛素抵抗、超重与肥胖、血脂异常）之间的关系。为以后治疗肥胖性高血压这类合并性高血压时提供一个以AngⅡ为靶点的新思路。
研究方法
以2589例年龄在20岁及以上并排除已知的脑卒中、冠心病和肾脏病患者的蒙古族常住居民为研究对象，采用横断面调查的方法，调查收集人口统计学、病史相关资料和生活方式危险因素资料，测量血压、身高、体重、腰围，并现场采集血标本低温保存运回实验室检测总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、血糖、胰岛素和Ang II等指标。双人双遍录入Epidata数据库，采用软件SPSS16.0进行统计分析。比较Ang II正常组和Ang II升高组的基本人口学特征和各项高血压代谢性危险因素的差异，运用单因素和多因素Logistic回归模型分别分析不同Ang II水平与高血压及其代谢性危险因素（高血糖、胰岛素抵抗、超重与肥胖、血脂异常）之间的关系，计算比值比（odds ratio，OR）和95%可信区间，并作趋势性检验。
研究结果
1.在纳入研究的2559名研究对象中，按照AngⅡ的上四分位点分组后，AngⅡ正常组有1919人，AngⅡ升高组共640人。AngⅡ升高组的男性、吸烟、饮酒者和心血管疾病家族史的比例以及血压、血糖、胰岛素、血脂中甘油三酯的平均水平均高于Ang II正常组，差异有统计学意义（P<0.05）。而两组比较，年龄、体质指数、腰围以及血脂中的胆固醇、低密度脂蛋白、高密度脂蛋白的平均水平的差异不具有显著性（P>0.05）。
2. AngⅡ正常组的高血压、胰岛素抵抗、超重、中心性肥胖和高甘油三脂的患病率分别为34.5%、23.7%、27.1%、41.3%和8.9%；而AngⅡ升高组这些代谢性危险因素的患病率依次分别为46.0%、28.5%、26.8%、41.6%和14.4%；其中，高血压、胰岛素抵抗和高甘油三酯这三个指标在两组的患病率差异有统计学意义（P<0.05），而超重和中心性肥胖两者差异无统计学意义（P>0.05）。
3.根据不同代谢性危险因素分组后，两组AngⅡ水平比较显示：高血压患者、胰岛素抵抗患者、高甘油三脂患者相对于正常组拥有一个更高的AngⅡ水平（52.0vs47.0pg/ml；48.0vs51.9；57.8vs48pg/ml），差异均有统计学意义（P<0.001）；而其他代谢性危险因素包括空腹血糖受损、肥胖、血脂异常中的高胆固醇、低高密度脂蛋白、高低密度脂蛋白的患者和正常人群中AngⅡ水平的分布差异无统计学意义（P>0.05）
4.不同AngⅡ水平下，收缩压和舒张压多因素调整后的协方差分析与趋势性检验结果都有统计学意义（P<0.05），经多因素调整后，相对于AngⅡ的最低分位，AngⅡ最高分位高血压前期的危险性上升至1.52倍；高血压的危险上升至1.95倍，均P<0.05。
5.无论是单因素还是多因素Logisitic回归，AngⅡ最高分位高血糖危险性的OR值和趋势性检验都无统计学意义，P>0.05。但计算不同AngⅡ水平胰岛素增高的危险性结果显示：调整了性别、血压、血糖、血脂后，Ang II水平＞71.3pg/ml组出现胰岛素增高危险性的OR值为1.71，可信区间为1.31-2.23。经趋势性检验，Ang II水平与胰岛素增高的OR值之间存在剂量反应关系，均P<0.05。
6.调整了多因素后，与AngⅡ≤40.0pg/ml者比较，AngⅡ在40.0～49.0pg/ml、49.0～71.3pg/ml、＞71.3pg/ml的研究对象胰岛素抵抗的OR值（95%CI）分别为1.17（0.90,1.57）；1.33（1.03,1.71）和1.43(1.10,1.85)。趋势性检验结果显示，随着AngⅡ水平的增加研究对象胰岛素抵抗的危险性增加，P<0.05。
7.调整了年龄、性别、吸烟、饮酒、血压、血糖、胰岛素、TC、TG、HDL-C、LDL-C后，未发现AngⅡ与超重和中心性肥胖的关联，P>0.05。
8.不同AngⅡ水平下，研究对象患血脂异常的危险性并没有随AngⅡ水平的增加而增加。我们试探性的研究不同血脂异常情况下指标水平与AngⅡ升高的关联性，结果显示：不管是单因素还是多因素Logisitic回归分析，高TC、高LDL-C和低HDL-C与研究对象中AngⅡ升高的关联都无统计学意义，P>0.05。但是对于高TG，调整年龄、性别、吸烟、饮酒、血压、血糖、胰岛素、BMI、腰围后，高TG患者AngⅡ升高的危险性是正常人群的1.51倍，趋势性检验结果显示，随着TG水平的增加，AngⅡ升高的可能性就越大，P<0.05。
结论
1..高血压患者、胰岛素抵抗患者、高甘油三脂患者中Ang II浓度高于正常人群，Ang II增高与高血压、胰岛素抵抗和高甘油三酯有关联。
2.对于该研究人群，未发现AngⅡ与糖尿病、超重与肥胖和血脂异常中高胆固醇、低-高密度脂蛋白和高-低密度脂蛋白的关联。
Background
The incidence of hypertension is often accompanied with a variety of metabolicabnormalities. Currently, relationships between Angiotensin II (Ang II) and metabolicrisk factors of hypertension are rarely reported and not yet conclusive both at home andabroad.
Purpose
This thesis is aimed at exploring the relationships between Ang II and hypertensionas well as its metabolic risk factors (high blood glucose, insulin resistance, overweightand obesity, dyslipidemia) in Mongolian; The results can provide a new way oftargeting Ang II for the future treatment of combined hypertension, such as obesity.
method
2559Mongolian ordinarily residents aged20years and above were studied, andknown patients of stroke, coronary heart disease, and kidney patients were excluded.Using cross-sectional survey, data on demographic characteristics, history of diseasesand lifeway risk factors were collected and blood pressure, height and weight, waistcircumference were measured.The blood samples were collected in site and werecryopreserved and transported to the laboratory for detection of cholesterol,triglycerides, high-density lipoprotein, low-density lipoprotein, glucose, insulin,Ang IIand other indicators. The indicators were recorded into Epidata database double timesby two persons, and analyzed by SPSS16.0software. The differences of demographiccharacteristics and metabolic risk factors of hypertension between the normal Ang IIgroup and the increased Ang II group were compared,and the relationships betweendifferent Ang II levels and hypertension as well as its metabolic risk factors (highblood glucose, insulin resistance, overweight and obesity, dyslipidemia) were analyzed by using single and multiple logistic regression model; odds ratios (ORs),95%confidence interval (95%CI) and the trend test were calculated.
Results
1. The2589subjects in the study were grouped in accordance with AngII quartile,and there are1919subjects in the normal Ang II group while640in the increased AngII group. In the increased Ang II group, the proportions of male, smoking and drinking,and family history of cardiovascular disease was higher than the normal group, so werethe levels of blood pressure, blood glucose, insulin, triglycerides of lipids, thedifferences were statistically significant (P<0.05). However, in the two groups,differences in age, body mass index, waist circumference and cholesterol, low-densitylipoprotein, high density lipoprotein were not statistically significant (P>0.05).
2. The prevalences of hypertension, insulin resistance, overweight, central obesityand high triglycerides were34.5%,23.7%,27.1%,41.3%and8.9%in the normal AngIIgroup,respectively. The corresponding prevalences were46.0%,28.5%,26.8%,41.6%and14.4%in the AngII increased group.The differences in prevalences of high bloodpressure, insulin resistance, and high triglyceride were statistically significant betweenthe two group (P<0.05), but differences in overweight and central obesity were notstatistically significant (P>0.05).
3. Being grouped according to the different risk factors, the Ang II level wascompared: patients with high blood pressure, insulin resistance and high triglycerideshad a higher level of Ang II relative to the normal group (52.0vs47.0pg/ml;48.0vs51.9;57.8vs48pg/ml), and the differences were statistically significant (P <0.001);but distribution of Ang II level in patients with other metabolic risk factors such asimpaired fasting plasma glucose, obesity, dyslipidemia, high cholesterol, low HDL orhigh LDL was not statistically significant (P>0.05).
4. For different Ang II levels, adjusted covariance analysis and trend test resultswere statistically significant of systolic and diastolic pressure (P<0.05). Aftermultivariate adjustment, compared to the lowest AngII quintile, the prehypertension riskof the highest quintile rose to1.52times; the risk of hypertension rose to1.95times,both P <0.05.
5. After logisitic regression, whether single factor or multi-factor, the OR value andthe trend test of the risk of high blood glucose were not statistically significant, P>0.05. However, results of the risk of increased insulin with different Ang II levels showed that,after adjusting for sex, blood pressure, blood sugar and blood lipids, the OR value ofinsulin increased risk in the Ang II>71.3pg/ml group was1.71, and the confidenceinterval was1.31-2.23. By the trend test, dose-response relationship was existedbetween Ang II levels and OR value of increased insulin, both P <0.05.
6. After adjusting for the multi-factor, compared with Ang II≤40.0pg/ml, the ORvalues(95%CI) of insulin resistance for objects with Ang II in40.0~49.0pg/ml,49.0~71.3pg/ml,>71.3pg/ml were1.17(0.90,1.57),1.33(1.03,1.71) and1.43(1.10,1.85),respectively. The trend test results showed that risk of insulin resistance wasincreased with AngII levels increasing, P <0.05.
7. After adjusting for age, sex, smoking, alcohol consumption, blood pressure,blood glucose, insulin, TC, TG, HDL-C, LDL-C, Ang II was not found associated withoverweight and central obesity, P>0.05.
8. For different Ang II levels, risk of suffering from dyslipidemia was did notincrease with the Ang II levels increased. We caculated the association of differentdyslipidemia and increasing Ang II, the results showed: whether single or multiplelogistic regression analysis,the relationships of Ang II and high TC, high LDL-C andlow HDL-C were not statistically significant (P>0.05). But for high TG, after adjustingfor age, sex, smoking, alcohol consumption, blood pressure, blood glucose, insulin,BMI and waist circumference, the risk of increased Ang II is1.51times higher than thenormal TG. The results of trend test showed that the Ang II levels increased as TG levelsincreased, P <0.05.
Conclusion
1. Ang II levels were higher participants with hypertension,insulin resistance,hightriglycerides than those in the normal population, increased Ang II level is a risk factorof hypertension, insulin resistance and high triglycerides.
2.The significant relationships between Ang II and diabetes, overweight andobesity, high cholesterol, low-high density lipoprotein and high-low density lipoproteinwere not found among study population.
引文
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