眼科における高血圧症と耐糖能異常

Relationship between glucose tolerance and retinal arteriolar sclerosis in hypertension

　高血圧症の耐糖能への影響を知るため，高血圧患者30例．正常血圧者34例に対し眼底検査により硬化性病変の有無および程度を確認後，75gブドウ糖経口負荷試験を施行し，血糖および血中インスリン動態を検討した．

　高血圧患者では．硬化性変化の高度なもので境界型GTTを示し，インスリン曲線上極値発現の遅延が認められた．硬化性変化が軽度のものでは，正常群と血糖値に有意差を認めなかったが，全経過を通じ比較的高値を示した．またインスリン曲線は極値のはっきりしない特異な形状を示した．Insulinogenic indexは，高血圧症患者で正常群に比し有意に低値であった（p＜0.05）．血中インスリン量の総和は高血圧症の有無で有意差を認めなかった．したがって，高血圧症においては硬化性変化が軽度な時期から耐糖能異常が存在しており，それに続発する細動脈硬化性変化により更に悪化していくものと考えられた．

We evaluated the retinal vascular changes and glucose capacity in chronic systemic hypertension in 30 hypertensive and 34 non-hypertensive subiects as control. Blood sugar and serum insulin levels were measured before and after intake of 75g oral glucose. These values were compared with the degree of arteriolar sclerosis as determined by oph-thalmoscopy.

In hypertensive subjects, an impaired glucose tole-rance test became manifest in the early stage of hypertension without marked retinal arteriolar scle-rosis. A delay of insulin release was also observed.The tolerance capacity curve showed no definite peak but sustained high insulin level. In hypertensive subjects with advanced retinal arteriolar sclerosis, the insulinogenic index was lower with still enhanced serum insulin level. The findings indicate that an impaired glucose tolerance appears in the early stage of hypertension and that it proceeds with the progression of arteri-olar sclerosis as secondary to continued hyperten-sion.