社区高血压人群伴发代谢综合征及其组分的临床特征

Characteristic of Hypertensive Subjects with Metabolic Syndrome and Its Components in Communities

目的分析社区高血压人群伴发代谢综合征及其组分的临床特征。方法分别测定5628例20岁以上社区研究对象的身高、体重、腰围(W)、臀围、收缩压(SP)、舒张压(DP)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、餐后2h血糖(2hPG)、空腹胰岛素(FIN)及餐后2h胰岛素(2hIN);计算体重指数(BMI)、腰臀比(WHR)、胰岛素抵抗指数(HOMA-IR)。根据1999年WHO代谢综合征诊断标准分为无代谢异常组、单纯高血压组、高血压伴1项其他代谢异常组、高血压伴2项其他代谢异常组及高血压伴3项其他代谢异常组。结果在高血压人群中,单纯高血压占15·37%,高血压伴1项其他代谢异常占32·40%,高血压伴2项其他代谢异常占33·36%,高血压伴3项其他代谢异常占18·87%。校正年龄、性别后,高血压者无论是否伴有其他代谢异常,BMI、W、WHR、TC、TG、LDL-C、FPG、2hPG、FIN及2hIN均较无代谢异常者显著升高(P<0·05,P<0·01);高血压伴其他代谢异常各组的BMI、W、WHR、TC、TG、LDL-C、FPG、2hPG、FIN、2hIN较单纯高血压组显著升高(P<0·01)。高血压个体无论伴或不伴其他代谢异常均存在显著的胰岛素抵抗,高血压伴随的代谢综合征组分越多,胰岛素抵抗的发生频率越高。多元逐步回归分析显示,BMI、SP、FPG、2hPG、FIN、2hIN及TC均是影响HOMA-IR的危险因素。结论社区高血压人群中,单纯高血压者少见,近85%的高血压患者存在1项或1项以上的其他代谢异常,超过1/2的高血压患者存在代谢综合征;社区高血压人群无论是否伴有其他代谢异常组分,总体脂、局部体脂、TC、TG、LDL-C、胰岛素水平均显著升高;高血压患者存在显著的胰岛素抵抗,胰岛素抵抗程度随个体合并代谢综合征组分的增多而加剧;总体脂、血糖、胰岛素、TC及SP分别是机体胰岛素抵抗的影响因素。

Objective To study the clinical characteristics of hypertensive subjects with metabolic syndrome and its components in communities. Methods Totally 5 628 subjects aged over 20 years were included. Measurement indicators included height, weight, waist circumference （W）, hip cireumference, systolic pressure （SP）, diastolic pressure （DP） , total cholesterol （TC）, triglyceride （TG） , high-density lipoprotein cholesterol （HDL-C）, low-density lipoprotein cholesterol （LDL-C）, fasting plasma glucose （FPG）, 2 h postprandial plasma glucose （2hPG）, fasting serum insulin （.FIN）, and 2 h postprandial serum insulin （2hIN）. Body mass index （BMI） , waist to hip ratio （WHR） , and homeostatic model approach-insulin resistance index （HOMA-IR） were calculated. According to 1999 WHO definition of metabolic syndrome, these individuals were divided into 4 groups： non-metabolic disorder group, isolated hypertension group, hypertension with one component of metabolic syndrome group, hypertension with two components of metabolic syndrome group, and hypertension with three components of metabolic syndrome group. Results Among subjects with hypertension, 15.37% were patients with isolated hypertension, 32. 40% with one component of metabolic syndrome, 33.36% with two components of metabolic syndrome, and 18. 87% with three components of metabolic syndrome. BMI, W, WHR, TC, TG, LDL-C, FPG, 2hPG, FIN, 2hIN and HOMA-IR in three groups （ hypertension with one component of metabolic syndrome group, hypertension with two components of metabolic syndrome group, and hypertension with three components of metabolic syndrome group） significantly increased than those in isolated hypertension group （ P 〈 0. 01 ）. The hypertensive patients showed a higher insulin resistance, despite other metabolic disorders. Furthermore, the hypertensive patients with more components of metabolic syndrome showed a higher chance to get insulin resistance. Multiple stepwise regression analysis showed FPG, 2hPG, FIN, 2hIN, BMI, SP and TC were risk factors of HOMA-IR Conclusions Patients with isolated hypertension are rare in community-hased population. About 85% of hypertensive patients have more than one metabolic disorders, more than half of were metabolic syndrome. The percentage of total body fat, levels of plasma glucose, serum insulin, total cholesterol and systolic blood pressure are independent risk factors of insulin resistance.