胰岛素抵抗与老年高血压病颈动脉粥样硬化关系的研究

Association between carotid atherosclerosis and insulin resistance in elderly patients with essential hypertension

目的探讨胰岛素抵抗(IR)与老年高血压颈动脉粥样硬化(AS)的关系及前者在老年高血压发生发展过程中对AS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IR分为两组,即高血压合并IR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(FSI)/空腹血糖(FSG),AI/AG,斑块积分,测量体质量、身高计算体质量指数(BMI),同时选取同龄30例正常血压者作为对照,应用直线相关分析观察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IR组的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IR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);IMT与SBP、FSI呈正相关(r值为0.003、0.129,均P<0.01),IMT与ISI呈负相关(r值为-0.125,P<0.01)。PS与SBP、FSI呈正相关(r值为0.018、1.233,均P<0.05),PS与ISI呈负相关(r值为-0.701,P<0.05)。结论IR与老年高血压颈动脉粥样硬化密切相关,老年高血压合并IR加重颈动脉粥样硬化程度和进程,即较单纯老年高血压对颈动脉硬化损害更严重。IR在老年高血压的发生、发展过程中可能起重要作用。与IR相关的高胰岛素血症是参与和促进老年高血压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 IR on the atherosclerosis. Methods According to insulin sensitivity index （ISI）, 70 cases of EH were divided into hypertension group （36 cases）, hypertension complicated with IR group （34 cases）. The oral glucose tolerance test and insulin release test were performed in all the 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） were calculated. Thirty healthy subjects were recruited as control （contrast group）. Correlation between IMT, PS and 7 insulinsensitivity parameters were respectively obtained using linear regression analysis. Results The values of IMT and PS in hypertension complicated with IR group were significantly higher than those of contrast group （P 〈 0.01）, hypertension complicated with IR group was higher than EH group,EH group was higher than control group. IMT was positively correlated with SBP, FSI（ r = 0. 003,0. 129, both P 〈0.01）, inversely correlated with ISI（ r = - 0. 125, P 〈 0.05）, PS was positively correlated with SBP, FSI （ r = 0. 018, 1. 233, both P 〈 0.05）, inversely correlated with ISI （r = -0. 701, P 〈0.05）. Conclusion IR is closely relative to carotid IMT and plaque formation in EH patients of elderly patients.