老年高血压患者血压昼夜节律与胰岛素抵抗

Relationship between dynamic blood pressure circadian and insulin resistance in elderly hypertension patients

目的为了探讨高血压病患者２４ｈ血压昼夜节律变化与糖、胰岛素（ＩＳ）代谢的关系。方法４６例老年高血压病患者，按昼夜血压节律不同，分为杓型组（ＤＧ）与非杓型组（ＮＤＧ），行葡萄糖耐量试验和ＩＳ释放试验。结果ＤＧ与ＮＤＧ２组各时相血糖、血糖面积及空腹ＩＳ水平无显著性差异（Ｐ＞００５）；而ＮＤＧ在糖负荷后的６０ｍｉｎ、１２０ｍｉｎＩＳ水平和ＩＳ释放指数（ＩＲＩ）以及ＩＳ面积（ＩＡＵＣ）明显高于ＤＧ（Ｐ＜００１、００５、００１、０００１、００１）；ＤＧ的ＩＳ敏感指数（ＩＳＳＩ）明显大于ＮＤＧ（Ｐ＜００１）；夜间平均血压下降率与ＩＡＵＣ、１２０ｍｉｎＩＲＩ及６０ｍｉｎＩＳ水平呈显著负相关（γ＝－０５９８、－０５１１和－０４８６，Ｐ＜００１、００１和００５），与１２０ｍｉｎＩＳＳＩ呈显著正相关（γ＝０４６２，Ｐ＜００１）。结论老年高血压节律异常者有更显著的胰岛素抵抗及高胰岛素血症。

Objective To investigate relationship between blood pressure (BP) circadian and glucose metabolism and insulin (INS)metabolism in patients with hypertension. Methods To observe forty six elderly hypertensive patients,were divided into two groups:dipped groups(DG)and non dipped groups(NDG),according to circadian BP,oral glucose tolerance test and the peaks of insulin release were measured. Results There were no obvious changes of blood glucoses(BG)and the areas under the curves (AUC)of BG( P >0 05),60 min and 120 min.Insulin levels in the patients of NDG were significantly higher than those of DG( P <0 05);there were no obvious changes of the levels of fasting serum INS( P >0 05);I AUC and 60 min,120 minINS release index(IRI)in the patients of DG were higher than in those of NDG( P <0 01,0 01,0 001);INS sensitivity index(INSSI)in the patients of DG were significantly higher than in those of NDG( P <0 01);the reduction of mean nighttime BP was negatively correlated with I AUC,120 min IRI and the levels of INS( r =-0 598,-0 511 and -0 486, P <0 01,0 01 and 0 05),and positively with 120 min INSSI( r =0 486, P <0 01). Conclusions The results indicated that there were significant INS resistance and hyperinsulinemia in the elderly patients with hypertension of abnormal circadian.