老年高血压病合并胰岛素抵抗与颈动脉粥样硬化关系的探讨

Relationship Between Insulin Resistauce and Carotid Atherosclerosis in Hyportension

目的:探讨胰岛素抵抗与老年高血压病颈动脉粥样硬化的关系及前者在老年高血压病发生发展过程中对动脉粥样硬化的参与影响作用。方法:选取70例老年高血压患者,按其是否合并胰岛素抵抗分为两组,即高血压合并胰岛素抵抗组(34例)和单纯高血压组(36例),并行口服葡萄糖耐量试验和同步胰岛素释放试验。同时做彩超测:颈动脉内膜中层厚度(IMT)、斑块厚度(Crouse法计算斑块积分)。根据公式计算出胰岛素敏感指数(ISI),血糖曲线下面积(AG),胰岛素曲线下面积(AI),空腹血胰岛素/空腹血糖,AI/AG,斑块积分,测量体重身高计算体重指数(BMI),同时选取同龄30例正常血压者作为对照,应用单元和多元回归分析观察ISI和斑块积分(PS)与各胰岛素敏感性指标的关系。结果:高血压合并胰岛素抵抗组的颈动脉内膜中层厚度(IMT)、粥样硬化斑块积分(PS)显著高于对照组(P<0.01),高血压合并胰岛素抵抗组的高于单纯高血压组(P<0.05),高血压组高于对照组(P<0.05);EH组的IMT与AI呈正相关(r值分别为0.394,P<0.05),与ISI呈负相关(r值为-0.329,P<0.05);PS与FSI呈正相关(r值为0.308,P<0.05);IMT与SBP、FSI呈正相关(r值为0.444、0.352,P<0.05),IMT与ISI呈负相关(r值为-0.425,P<0.05)。PS与SBP、FSI呈正相关(r值为0.293、0.381,P<0.05),PS与ISI呈负相关(r值为-0.286,P<0.05)。逐步回归分析显示胰岛素敏感指数、收缩压与颈动脉内膜中层厚度相关性较为密切,其标准回归系数分别为-0.094,0.002。收缩压、胰岛素与PS较为密切,其标准回归系数分别为0.001,0.064。结论:胰岛素抵抗与老年高血压颈动脉粥样硬化密切相关,老年高血压合并胰岛素抵抗加重颈动脉粥样硬化程度和进程,即较单纯老年高血压病对颈动脉硬化损害更严重。胰岛素抵抗在老年高血压的发生、发展过程中可能起重要作用。与胰岛素抵抗相关的高胰岛素血症是参与和促进老年高血压病发生动脉粥样硬化的重要影响因素。

Objective：To investigate the associations between carotid atherosclerosis and the insulin resistance（IR） in elderly patients with essential hypertension（EH） and the effect of the insulin resistance on the atherosclerosis.Methods： According to Insulin sensitivity index（ISI）,Hypertension group（36cases）,Hypertension complicated with Insulin resistance group（34cases）.The oral glucose tolerance test and insulin release test were performed in all patients and 30 healthy subjects.The area under glucose tolerance curve（AG）,area under insulin release curve（AI）,fasting serum insulin/fasting serum glucose（FSI/FSG） ratio,AI/AG ratio and ISI were calculated.Carotid intima-media thickness（IMT） and carotid atherosclerosis plaque thickness,Plaque score（PS） was calculated.Thirty healthy subjects were recruited as control.Correlation between IMT,PS and 7 insulin-sensitivity parameters were respectively obtained using linear regression analysis,and the stepwise regression analysis was used to assess the independent effect of each parameter.Result： IMT and PS was significantly higher in Hypertension complicated with Insulin resistance group than contrast group（P〈0.01）,IMT was positively correlated with AI（r=0.394,P〈0.05）,inversely correlated with ISI（r=-0.329,P〈0.05）,PS was positively correlated with FSI（r=0.358,P〈0.05）,in hypertension group;IMT was positively correlated with FSI、SBP（r=0.352,0.444,P〈0.05）,inversely correlated with ISI（r=-0.425,P〈0.05）,PS was positively correlated with FSI、SBP（r=0.381,0.293,P〈0.05）,inversely correlate with ISI（r=-0.286,P〈0.05）,Multiple stepwise regression analysis showed that SBP、ISI was correlated with IMT,SBP、FSI were correlated with PS.Conclusion： IR were closely relative to carotid IMT and plaque formation in EH patients of elderly patients.