老年代谢综合征患者颈动脉粥样硬化改变研究

Change of Carotid Atherosclerosis in Elderly Patients Suffering from Metabolic Syndrome

目的探讨老年代谢综合征患者代谢紊乱与颈动脉粥样硬化的关系。方法将120例老年患者分为代谢综合征组(MS)、糖尿病组(DM)、糖耐量减低组(IGT)、高血压病组(EH),每组30例,比较4组患者胰岛素释放试验中糖代谢改变情况,血脂改变情况,颈动脉超声检测结果。结果MS组患者空腹胰岛素(INS)、3hINS、HomaIR指数与其他3组间差异有显著性意义(P<0.05)。MS组患者HomaB高于DM组(P<0.05),但低于IGT组、EH组(P<0.05)。TG水平MS组高于EH组(P<0.05),HDL-C水平MS组低于EH组(P<0.05),LDL-C水平MS组与EH组间差别无显著性意义(P>0.05)。MS组患者颈动脉内膜较DM组、IGT组肥厚(P<0.05)。Logistic回归分析显示,MS组患者在BMI、腰围、HomaIR指数与颈动脉内膜厚度(IMT)、颈动脉粥样硬化斑块数呈现明显的递增性,且与严重程度成正比,其他3组的递增性不如MS组明显。结论老年代谢综合征患者代谢紊乱与颈动脉粥样硬化的关系密切,与严重程度成正比;较单纯糖尿病、糖耐量减低、高血压病患者颈动脉粥样硬化更严重。

Objective To study the relationship between metabolic disorder and carotid atherosclerosis in the elderly patients suffering from metabolic syndrome. Methods Totally 120 patients were divided into 4 groups： metabolic syndrome （MS）, diabetes mellitus （DM）, impaired glucose tolerance （IGT）, essential hypertension （EH） groups, with 30 in each group. And the change of sugar metabolism in the Insular Releasing Test, the alteration of blood lipid, and the results of carotid ultrasound test for the 4 groups were compared. Results The indices of fasting INS, 3 hINS and Homa IR in the MS group was higher than those in the other three groups, with a significant difference （ P 〈 0. 05 ）. The Homa B index in MS group was significantly higher than that in DM group （ P 〈0.05） , and significantly lower than those in IGT and EH groups （ P 〈0.05）. The TG level in MS group was higher than that in EH group （ P 〈 0. 05 ）. The HDL - C value in MS group was lower than that in EH group （ P 〈 0.05 ）. No significant difference was found of the LDL - C level between MS group and EH group （ P 〉 0.05 ）. The inner membrane of carotid in MS group was thicker than those in DM and IGT group （ P 〈 0. 05 ）. The logistic regression analysis showed in MS group there was a significant increase in the body mass index, waistline value, Homa IR index, thickness of inner membrane of carotid, and number of atherosclerotic plaques of carotid, and it was proportional to the disease severity. However, the increase in other three groups was less than that in MS group. Conclusion The metabolic disorder in the elderly patients suffering from metabolic syndrome is closely related to carotid atherosclerosis, and proportional to the disease severity. The degree of carotid atherosclerosis in MS group is more severe than those in DM, IGT and EH groups.