高血压和糖尿病对老年人心血管病变的影响

Effects of diabetes and essential hypertension on cardiovascular diseases in the elderly

目的探讨原发性高血压(EH)和糖尿病(DM)对老年人心血管病变的影响。方法根据血压、空腹血糖(FPG)及餐后2h血糖(PG2h)检测结果,172名老年人分为4组:健康对照组、DM组、EH组和EH伴DM组。颈动脉超声测量颈总动脉(CCA)内膜中层厚度(IMT)、颈内动脉(ICA)IMT、颈动脉最大血流速度(PSV)、颈动脉阻力指数(RI)等指标。超声心动图测量左房内径(LAD)、左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs)、室间隔厚度(IVST)、左室后壁厚度(LVPW)、左室重量指数(LVMI)、相对室壁厚度(RWT)、peakE/A、左室短轴缩短率(FS)。测量FPG、PG2h、空腹血清胰岛素(FINS)和餐后2h血清胰岛素(INS2h),计算胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能指数。结果与健康对照组比较,DM组和EH伴DM组的PG2h、FINS、INS2h和HOMA-IR均显著升高(P<0.01),EH组、DM组和EH伴DM组的CCA-IMT和ICA-IMT显著增大(P<0.01或P<0.05),EH组及EH伴DM组的IVST、LVPW、LVMI和RWT显著增大(P<0.01或P<0.05),peakE/A显著减小(P<0.05)。与DM组比较,EH组和EH伴DM组的CCA-IMT和ICA-IMT显著增大(P<0.05)。结论EH能明显改变老年人颈动脉IMT、左室室壁厚度及舒张功能;而DM能增加老年人颈动脉IMT,但对心脏结构和功能影响不大。

Objective To investigate the effects of diabetes （DM） and essential hypertension （EH） on the cardiovascular diseases in the elderly. Methods According to the blood pressure, fasting plasma glucose （FPG）and 2 h postprandial blood glucose （PG 2 h）, 172 elder subjects were divided into： healthy control group, DM group, EH group and EH-DM group. Common carotid artery intima-media thickness（CCA-IMT） ,internal carotid artery i ntima-media thickness（ ICA-IMT）, carotid artery peak systolic velocity（PSV） and carotid artery resistance index （ RI ） were measured by carotid uhrasoud. Left atrial diameter （ LAD ）, left ventricular end-diastolic diameter （ LVDd）, left ventricular end-systolic diameter（ LVDs ）, interventricular septum thickness （ IVST）, left ventricular posterior wall thickness （LVPW）, left ventricular mass index （LVMI）, relative wall thickness （RWT）, peak E/A and left ventrieular fractional shortening （FS） were examined by echoeardiography. FPG, PG 2 h, plasma insulin （FINS）and 2 h postprandial insulin（ INS 2 h ）were detected to calculate the homeostasis model assessment insulin resistanee（HOMA-IR）and HOMA-β cell index（HBCI）. Results Compared with healthy control group, PG 2 h, FINS, INS 2 h and HOMA-IR in DM group and EH-DM group significantly increased （P 〈 0.01 ） ;CCAIMT and ICA-IMT in EH group, DM group and EH-DM group became thicker（P 〈 0.01 or P 〈 0.05 ） ; IVST, LVPW, LVMI and RWT in EH group and EH-DM group significantly increased（P 〈0.01 or P 〈0.05） ,and peak E/A in EH group and EH-DM group was significantly decreased （P 〈 0.05 ）. CCA-IMT and ICA-IMT in EH group and EH-DM group were significantly thicker than in DM group（ P 〈 0.05 ）. Conclusion EH can significantly change the carotid artery IMT,left ventricular wall thickness and diastolic function in the elderly. DM can increase the carotid artery IMT, but have limited impact on the cardiovascular structure and function.