胰岛素抵抗与心血管病危险因素聚集性关系研究

THE ROLE OF INSULIN RESISTANCE IN THE CLUSTERING OF CARDIOVASCULAR RISK FACTORS

为观察胰岛素抵抗与心血管病危险因素聚集性的关系，分析了１０６例高血压及冠心病病人和３２例正常人的胰岛素水平及胰岛素敏感性。结果显示：（１）无心血管病危险因素时，胰岛素敏感性指数为－１．４８±０．０９，随着危险因素聚集程度增加，轻度聚集（２项危险因素）时为－１．９５±０．１７，重度聚集（≥３项危险因素）达－２．１４±０．２１。与正常组比差异有显著性（Ｐ＜０．０１）。提示随着危险因素逐渐聚集增加，胰岛素抵抗加重；（２）女性病人胰岛素抵抗与血尿酸呈正相关（ｒ＝０．３７８，Ｐ＜０．０５），男性病人无明显相关（ｒ＝０．３４，Ｐ＝０．１４５）；（３）绝经前后妇女相比，敏感性指数分别为－１．７３±０．１３和－２．２３±０．２９（Ｐ＜０．０５）。绝经后胰岛素敏感性下降。以上结果表明胰岛素抵抗与心血管病危险因素聚集性呈正相关。

The coexistence of multiple cardiovascular risk factors in the same individual is called a clustering of cardiovascular risk factors. Many studies have shown that this phenomenoa is associated with a increased morbility of cardiovascular disease, and insulin resistance may be the common link between the risk factors. This study was designed to link the clustering of cardiovascular risk factors with insulin resistance. Using a new insulin sensitivity index [-log (fasting serum Glu×Ins)] to evaluate the insulin resistance, we investigated the relationship between the insulin sensitivity and cardiovascular risk factors in 106 patients with hypertension or coronary heart disease and 32 normal subjects. The normal group without cardiovascular risk factors was selected as controls. The individual with 2 risk factors were defined as having mild clustering, and those with ≥3 risk factors as severe clustering. As the number of risk factors increased from 1 to ≥3, the insulin sensitivity index in creased from -1.69±0.24, -1.95±0.17 to -2.14±0.21 respectively. The insulin resistance was positively correlated with serum uric acid in women ( P < 0.05 ), but not in men ( P >0.05). The insulin sensitivity was more decreased in postmenopausal than in pre menopausal women. The insulin sensitivity index was -2.23±0.39 vs -1.73±0.13 ( P < 0.05 ). The insulin resistance is associated with a clustering of risk factors of cardiovascular disease, more cluste ring, more resistant.