藏族老年潜在高血糖者胰岛素抵抗与动脉粥样硬化的关系

Association between insulin resistance and atherosclerosis in elderly Tibetan people with latent hyperglycemia

目的:代谢综合征会导致动脉粥样硬化形成,但其程度具有种族差异性。观察不同胰岛素抵抗指数藏族老年患者动脉粥样硬化相关指标差异,分析藏族老年人胰岛素抵抗与动脉粥样硬化的关系。方法:①实验于2006-01/08由解放军西藏军区总医院和解放军总医院共同完成。共纳入760例藏族潜在高血糖患者,男464例,女296例;年龄(66±10)岁。有糖尿病家族史;曾经发现空腹或餐后血糖异常;明确诊断为糖耐量低减或2型糖尿病;均对检测指标知情同意。②对所有参试者进行体检、询问病史及口服75g葡萄糖耐量试验,采静脉血检测血脂及胰岛素水平,B型超声检查双侧颈总动脉内中膜厚度,稳态模型计算胰岛素抵抗指数,根据该指数0.21￣0.77,0.78￣1.06,1.07￣1.30,1.31￣1.84,1.85￣10.57分5组进行观察。③计量和计数资料差异比较分别采用方差分析和χ2检验。结果:患者760例均进入结果分析。①不同胰岛素抵抗指数患者平均内中膜厚度与内膜光滑程度比较,差异明显(F=7.39,18.48,P<0.01),胰岛素抵抗指数大的患者动脉硬化程度也较高。②多元回归分析结果显示,增龄、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、胰岛素抵抗指数自然对数与内中膜厚度独立相关(Beta值=0.237,0.182,0.263,0.216,0.284,P<0.05￣0.01),其中胰岛素抵抗指数自然对数的Beta值最大,表明胰岛素抵抗在动脉粥样硬化形成过程中起最重要的作用。③随着胰岛素抵抗指数增加,糖耐量异常、糖尿病、高血压、冠心病患病率显著升高(P<0.01)。不同胰岛素抵抗指数参试者的血糖、血脂、胰岛素水平差异明显(P<0.01)。结论:在藏族老年人群中,胰岛素抵抗参与动脉粥样硬化的形成,胰岛素抵抗指数大的患者动脉硬化程度也较高。

AIM： Metabolic syndrome could result in atherosclerosis with race differences. In this paper, we investigated the relationship between insulin resistance and atherosclerosis in Tibetan elderly people by comparing the related indexes of atherosclerosis in these people with different insulin resistant indexes. METHODS： ①The experiment was conducted in the General Hospital of Chinese PLA and Tibetan General Hospital of Chinese PLA from January to August 2006. 760 elderly Tibetan patients with latent hyperglycemia including 464 males and 296 females aged （66±10） years were selected. They had the history of diabetes and abnormal fasting or postprandial blood sugar, and had been identified as low sugar tolerance or type 2 diabetes mellitus. The informed consent was obtained from the subjects. ②All the subjects underwent physical examination, medical history inquiry and 75 g oral glucose tolerance test. Venous blood was sampled for the measurement of serum concentrations of lipid and insulin. The intima-media thickness was observed in bilateral common carotid arteries by B ultrasound; Insulin resistance index was calculated by homeostasis model assessment （HOMA-IR）. Subjects were grouped according to the threshold of HOMA-IR 0.21-0,77, 0.78-1.06, 1.07-1.30, 1.31-1.84, and 1.85-10.57. ③The measurement data and count data were compared with variance analysis and Х^2 -test. RESULTS： All 760 patients were involved in the result analysis. ①There were significant differences in the carotid intima-media thickness and smoothness among patients with different insulin resistance indexes （F =7.39, 18.84, P 〈 0.01）. With the increase in HOMA-IR, the incidence of atherosclerosis was increased. ②The multivariate regression analysis showed that ageing, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and natural logarithm of HOMA-IR were independently related to intima-media thickness （Beta value =0.237, 0.182, 0.263, 0.216, 0.284, P〈 0.05-0.01）, of which the Beta value of the natural logarithm of HOMA-IR were the biggest, indicating that insulin resistance played an important role in atherogenesis. ③With the increase in HOMA-IR, the incidence of impaired glucose tolerance, diabetes mellitus, hypertension and coronary artery disease was increased （P 〈 0.01）. The levels of blood glucose, fasting plasma and fasting insulin were different remarkably in patients with different HOMA-IR. CONCLUSION： Insulin resistance plays a role in atherogenesis in the eldedy Tibetan population. Those with larger HOMA-IR have atherosclerosis of higher degree.