肥胖的高血压病患者中医体质分类与胰岛素抵抗的关系

Relationship between Insulin Resistance and the Traditional Chinese Medicine Constitution Classification in Obese Patients with Essential Hypertension

[目的]探讨中医的体质分型与胰岛素抵抗的关系。[方法]按体质分型标准将一组肥胖的高血压病患者,分为阳亢质组(28例)和痰湿质组(34例),进行葡萄糖耐量试验(OGTT)和胰岛素释放试验(InRT)检测,采用胰岛素敏感指数(ISI)、胰岛素抵抗指标(Homa-IR)和胰岛β细胞功能指数(MBCI)等指标做比较分析。[结果]1.痰湿质组高血压病人胰岛素的水平高于阳亢质组高血压病人,尤其是空腹时和30分钟时的胰岛素值分别为1.03±0.24mU/L、1.93±0.22mU/L和0.85±0.17mU/L、1.72±0.38mU/L,差异明显且有统计学意义(P=0.002、0.01)。2.痰湿质组和阳亢质组2组ISI分别为-1.77±0.26、-1.60±0.17,(P=0.004);Homa-IR分别为0.41±0.26、0.25±0.17,(P=0.005);MBCI分别为16.92±14.89、8.83±6.76,(P=0.012)。[结论]痰湿质组高血压患者为维持血糖在正常水平,胰岛β细胞的功能是亢进的,胰岛素的分泌也明显增加,与阳亢质组相比,胰岛素的敏感性下降,胰岛素抵抗现象严重。痰湿质的高血压患者心血管的易损性可能比阳亢质组更明显。

[Objective] To investigate the relationship between the traditional Chinese medicine constitution classification and insulin resistance. [Methods] A group of obese essential hypertensives were classified according to the traditional Chinese medicine sorting standard, 28 patients were classified as Yangkang and 34 patients were classified as Tanshi. All subjects underwent both oral glucose tolerance test and insulin release test. Insulin sensitivity indices （ISI and HOMA-IR ） and β - cell function index （MBCI） were calculated and compared between Yangkang group and Tanshi group. [Results] （1） Serum insulin level, especially fasting insulin and 30-minute insulin, was significantly higher in Tanshi group than in Yangkang group （1.03±0.24 mU/L, 1.93 ± 0.22 mU/L vs 0.85±0.17 mU/L,1. 72±0. 38 mU/L, respectively） （P =0. 002,0.01）. （2）Compared with Yangkang group, Tanshi group had significantly decreased ISI （-1. 77±0. 26 vs -1.60±0. 17） （P=0. 004）, significantly increased HOMA-IR（0.41 ±0.26 vs0.25±0.17） （P=0.005） , and increased MBCI（16.92±14.89 vs 8.83±6.76）（P=0.012）. [Conclusion] InTanshihypertensives, insulin resistasnce is more severe, insulin secretion is upregulated in order to maintain normal glucose tolerance. It is likely that Tanshi hypertensives are more susceptible to cardiovascular disease than Yangkang hypertensives.