高血压患者糖代谢异常的评价

To evaluate the abnormality of glucose metabolism in essential hypertension

目的探讨高血压患者的糖代谢情况及其高危因素分析。方法对562例高血压患者进行口服葡萄糖耐量试验(OGTT),根据血糖分为正常葡萄糖耐量(NGT)、空腹血糖受损(IFG)、葡萄糖耐量减低(IGT)和糖尿病四组,分析各组的发病率,对各组的血脂(TG、TC、HDL、LDL)、体重指数、HOMA-IR、β细胞功能(HOMA-β)、胰岛素敏感性指数(ISI)、腰围、空腹胰岛素、餐后2小时胰岛素等进行比较。结果(1)高血压患者近2/3有糖代谢异常,发病率非常高,但知晓率很低,其中只有16%患者已知有糖尿病。(2)随糖代谢异常的加重,高血压患者的体重指数、腰围呈上升趋势,IFG和NGT组间比较无差异(P>0.05),IGT或糖尿病组,差异有显著性(P<0.05);血脂异常也越加明显,TG、TC、LDL呈上升趋势,HDL则下降;IGT组HOMA-IR明显升高(P<0.01),与糖尿病组比较无差异;IGT组HOMA-β细胞功能升高,与其他三组间比较无差异;糖尿病和IGT组ISI下降。结论高血压患者存在明显的糖耐量异常,随着糖耐量的加重,其他代谢异常也恶化;有必要对高血压患者进行糖耐量试验,做到早期发现早期干预,预防心血管并发症。

Objective To know the glucose metabolism in essential hypertension and analysis the risk factors of the group. Methods After 0GTT,562 patients with essential hypertension were divided into NGT,IFG,IGT and T2DM. The morbidity of each group had been made. Parameters such as TC ,TG,HDL, LDL,BMI ,waist,fasting insulin and postprandial 2hour insulin were detected. Homeostasis model assess-ment（HOMA-IR） ,HOMA-β and insulin sensitivity index（ISI） were applied to assess the status of insu-lin resistance and function of β -cell. Results The abnormality of glucose metabolism was about two thirds in the patients with essential hypertension, the morbidity was very high. Only 16% knew they had DM before the test. The ratio was low. As the abnormality of glucose metabolism worsen, BMI, waist, TG, TC, LDL were much higher, HDL lower （P〈0.05）. HOMA-IR and HOMA-β were higher in IGT group（P〈0.01） ,ISI decreased in IGT and DM. Conclusion There was the abnormality of glucose metabolism in essential hypertension. The worsen the glucose metabolism, the aggravated the other metabolism, such as lipid, In order to prevent vascular complication, the patients with essential hypertension should have OGTT earlier to find glucose metabolism abnormality.