老年男性高胰岛素血症患者的临床特点分析

Clinical features of aged male patients with hyperinsulinemia

目的 分析老年男性高胰岛素血症患者的临床特征及其影响因素。方法 对521例经糖尿病筛查的老年男性高危人群行口服75g葡萄糖耐量试验（OGTT），根据胰岛素测定结果分为高胰岛素血症组（n=195）和正常胰岛素组（n=326），对其临床特征、糖代谢状态构成比、胰岛p细胞功能及胰岛素抵抗指标、合并其他疾病情况进行比较，并分析高胰岛素血症患者2～10年间糖代谢状态转化与体重变化之间的关系。结果高胰岛素血症组的体重指数（BMI）、腰围、空腹血糖（FBG）、餐后2h血糖（2hPBG）、甘油三酯（TG）、收缩压、舒张压均明显高于正常胰岛素组（P〈0．01），高密度脂蛋白胆固醇（HDL-c）明显低于正常胰岛素组（P〈0．01），年龄、总胆固醇（TC）、腰臀比值（WHR）及低密度脂蛋白胆固醇（LDL-c）与正常胰岛素组比较无明显差异。高胰岛素血症组的糖代谢异常检出率（73．3％）明显高于正常胰岛素组（39．3％），其中高胰岛素血症组中新患2型糖尿病42例（21．5oA），糖调节受损者101例（51．8％），正常糖耐量者52例（26．7％），正常胰岛素组中新患2型糖尿病16例（4．9％），糖调节受损者112例（34．4％），正常糖耐量者198例（60．7％）。高胰岛素血症组胰岛B细胞功能、胰岛素抵抗指标也明显高于正常胰岛素组，在不同糖代谢状态分组中表现一致。高胰岛素血症组合并肥胖、高血压、高尿酸血症、血脂紊乱、心血管病的比例均高于正常胰岛素组。高胰岛素组中糖代谢状态转化情况显示体重增加或减少与糖耐量恶化或好转相关。结论老年男性糖尿病早期高危人群中，高胰岛素血症患者胰岛B细胞功能大多在正常范围，但多项代谢指标及合并其他代谢异常以及心脑血管疾病的比例均高于正常胰岛素者，应引起重视并给予综合防治。

Objective To analyze the clinical features of aged men with hyperinsulinemia, and to explore its influence factors. Methods 521 aged persons belonging to the high-risk population of diabetes mellitus （DM） were given 75g oral glucose tolerance test （OGTT）, and then divided into hyperinsulinemia group and normal insulin group according to the plasma insulin levels. Clinical features, glucose metabolism state, constituent ratio, complicating diseases, 13 cell function and insulin resistance were compared between the two groups. Insulin resistance was determined by HOMA-LR, and 13 cell function was determined by HOMA-13. The relationship between glycometabolic change and body weight was analyzed in hyperinsulinemia patients for a period of 2-10 years. Results 195 cases were in hyperinsulinemia group, and 326 cases were in normal insulin group. Compared with the latter, the subjects in hyperinsulinemia group showed higher values of BMI, waistline, fasting blood glucose （FBG）, postprandial glucose （2hPBG）, and systolic and diastolic blood pressure （SBP, DBP）（ P 〈0.01 or P〈0. 05）, and with lower value of HDL-c （P〈0. 01）. There were no significant differences in mean age, total cholesterol （TC）, waist：to-hip ratio （WHR） and LDL-C between the two groups. The incidence of anomalous glucose metabolism in hyperinsulinemia group （73. 3%） was higher than that in normal insulin group （39. 3%）. 42 cases （21. 5%） in hyperinsulinemia group were found to have type 2 diabetes, 101 cases （51.8%） found to have impaired glucose regulation （IGR） and 52 cases （26. 7%） showed normal glucose tolerance （NGT）. While in normal insulin group, 16 cases （4. 9%） were found to have type 2 diabetes, 112 cases （34. 4%） with IGR and 198 cases （60.7%） showed NGT. 13 cell function and insulin resistance index were higher in hyperinsulinemia group than that in normal insulin group. In hyperinsulinemia group, the prevalence of obesity, hypertension, hyperuricemia and dyslipidemia were higher than that in normal insulin group. The change in body weight （increase or decrease） was one of the influence factors in evaluating the outcome of carbohydrate tolerance （worse or improvement）. Conclusions Most of aged men with hyperinsulinemia show that the 13 cell function was within normal range, while the prevalence of metabolism abnormality, CHD and CVD were higher in normal insulin group. Therefore, special attention and integrated control measures should be given to such population.