男性高血压患者发生糖代谢异常的危险因素

Risk Factors for the Development of Abnormal Glucose Metabolism in Male Hypertensive Patients with Normal Glucose Tolerance

目的探讨正常葡萄糖耐量的男性高血压患者发生糖代谢异常的危险因素。方法对口服葡萄糖耐量试验(OGTT)正常的106例男性原发性高血压患者进行随访研究,随访前后测定OGTT、同步胰岛素释放试验(InRT)、血脂、血压、体重指数(BMI)及腰围,用HOMA-IR、胰岛素敏感性指数(ISI)及胰岛素代谢清除率(MCRi)计算胰岛素敏感性,用HOMA-β及胰岛素1相和2相分泌计算β细胞功能。结果(1)106例正常葡萄糖耐量(NGT)的男性原发性高血压患者,平均随访3年后,新发糖尿病6例(5.7%),进展为IGT的39例(36.8%),保持NGT的61例(57.5%);(2)随访后进展为IGT的患者与仍为NGT的患者相比较,前者随访前的腰围、BMI、空腹血糖、OGTT2h和3h血糖、OGTT2h胰岛素水平均显著增高(P<0.01),ISI及MCRi显著减低(P<0.01);(3)调整年龄、血压、血脂等因素后,多因素Lo-gistic回归显示腹型肥胖和OGTT2h血糖是男性EHT从NGT转为IGT的独立危险因素(OR值分别为6.81和2.13);(4)随访前有腹型肥胖的NGT高血压患者进展为IGT的比率明显高于无腹型肥胖者(60%vs19%,P<0.01)。比较随访前指标发现,腹型肥胖组的ISI和MCRi显著降低、糖负荷后胰岛β细胞分泌显著增强(P<0.01),随访前后比较,腹型肥胖组HOMA-IR和HOMA-β明显增高(P<0.01)。结论腹型肥胖和OGTT2h血糖是无糖代谢异常的男性原发性高血压患者发展为糖耐量异常的风险预测指标。胰岛素敏感性降低及胰岛β细胞功能增强与腹型肥胖的男性NGT高血压患者发生IGT有关。

Objective To evaluate the risk factors associated with the development of abnormal glucose metabolism in men with essential hypertension （EHT） and normal glucose tolerance （NGT）. Methods Male EHT patients with NGT were enrolled in a 3 years follow-up study. OGTT, insulin release test （InRT）, lipids, blood pressure, body mass index （BMI） and waist circumferences （WC） were measured at baseline and at follow-up HOMA-IR. Insulin sensitivity index （ISI） and metabolic clearance rate of insulin （MCRi） were determined, while the insulin secretion was investigated by HOMA-β, first-phase and second-phase of insulin release. Results （ 1 ） During the 3 years of follow-up, 6 of 106 subjects （5.7%） were newly diagnosed as diabetes, 39 （33.2%） developed IGT, and 61 （57.5%） remained with NGT; （2） Compared with the patients remaining in NGT, the IGT patients had significantly higher in baseline WC, BMI, plasma glucose level （fasting, OCTT 2 h and 3 h） and serum insulin level at OGTT 2 h（P〈0. 01 ） with lower ISI and MCRi （P〈0. 01 ） ; （3） After adjustment for age, blood pressure, lipids, logistic regression revealed that central obesity and plasma glucose level at OGTT 2 h were independent risk factors （OR 8. 49 and 2.13 respectively） ; （4） Baseline waist circumferences（WC） was significantly greater in patients who developed as abnormal glucose metabolism than that in subjects without central obesity （60% vs 19%, P〈0. 01 ）. Lower ISI and MCRi and a higher post-challenge function of pancreas islet β- cells were found in the patients of central obesity（P〈0. 01）. Conclusion Central obesity and plasma glucose level at OGTT 2 h are the two most important predictors for the development of IGT. Decreased insulin sensitivity and enbancement of βcells function are associated with the development of IGT.