老年高血压和冠心病患者的高胰岛素血症

Hyperinsulinemia in elderly patients with essential hypertension and coronary heart disease

目的探讨老年原发性高血压和冠心病患者的血胰岛素水平及胰岛素敏感性指数的变化。方法对无糖尿病病史的老年原发性高血压患者３０例、老年冠心病患者３２例、老年对照组３０例测定空腹及餐后２小时血糖、胰岛素、Ｃ肽值，计算胰岛素敏感性指数，进行对照分析。结果空腹胰岛素，高血压组为（１３．１±５．４）ｍＵ／Ｌ，冠心病组为（１１．１±０．３）ｍＵ／Ｌ，对照组为（１０．３±１．９）ｍＵ／Ｌ；餐后２小时胰岛素，３组分别为（６２．３±１６．８）、（４４．３±６．４）及（１０．８±３．１）ｍＵ／Ｌ。均为高血压组高于冠心病组，二者又高于对照组（分别为Ｐ＜０．０５及Ｐ＜０．０１）。胰岛素敏感性指数为对照组大于冠心病组，二者又大于高血压组（分别为Ｐ＜０．０１及Ｐ＜０．０５）。结论老年高血压患者及冠心病患者均伴有高胰岛素血症和胰岛素抵抗，胰岛素敏感性指数降低是血管病变的危险因素之一。

Objective To find the changes of serum insulin (Ins) and insulin sensitivity index (ISI) in essential hypertension (EH) and coronary heart disease (CHD). Methods The concentrations of fasting blood glucose (FBG), 2 hour postprandial blood glucose (PBG), serum insulin and C peptide (C P) were measured in 30 non diabetic patients with EH, 32 non diabetic patients with CHD and 30 elderly healthy controls. The ISI of each group was calculated and compared. Results Fasting serum insulin level was (13 1±5 4)mU/L in EH, (11 1±0 3)mU/L in CHD and (10 3±1 9)mU/L in controls. Postprandial serum insulin level was (62 3±16 8)mU/L in EH, (44 3±6 4)mU/L in CHD and (10 8±3 1)mU/L in controls. The insulin level in CHD group was higher than that of control group ( P <0 01), but lower than that of EH group ( P <0 05). Therefore, the ISI was greater in elderly healthy control group than in CHD group and EH group ( P <0 01 and P <0 05). Conclusions These results indicate that patients in EH group and CHD group are associated with hyperinsulinemia and insulin resistance and the reduction of ISI is one of the risk factors for angiopathy.