颈动脉内膜-中层厚度与老年高血压病胰岛素抵抗关系的探讨

Association Between Carotid Intima-media Thickness and Insulin Resistance in Elderly Patients with Essential Hyperttension

目的:通过对老年高血压病合并胰岛素抵抗与颈动脉内膜-中层厚度的临床分析和观察,分析探讨胰岛素抵抗与老年高血压病颈动脉粥样硬化的关系及前者在老年高血压病发生发展过程中对动脉粥样硬化的参与影响作用。方法:选取70例老年高血压患者,按其是否合并胰岛素抵抗分为两组即高血压合并胰岛素抵抗组(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)。根据公式计算出胰岛素敏感指数(ISI),测量体重身高计算体重指数(BMI),同时选取同龄34例正常血压者做为对照,应用单元和多元回归分析观察ISI胰岛素敏感性指标的关系。结果:高血压合并胰岛素抵抗组的颈动脉内膜中层厚度(IMT)显著高于对照组(P<0.0 1),高血压合并胰岛素抵抗组高于单纯高血压组(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0.444、0.352,P<0.05),IMT与ISI呈负相关(r值为-0.425,P<0.05)。结论:胰岛素抵抗与老年高血压颈动脉粥样硬化密切相关,老年高血压合并胰岛素抵抗加重颈动脉粥样硬化程度和进程,即较单纯老年高血压病对颈动脉硬化损害更严重。

Objective：To investigate the associations between carotid atherosclerosis and the insulin resistance（IR） in elderly patients with essential hypretension（EH）and the effect of the insulin resistance on the atherosclerosis.Methods：According to Insulin sensitivity index（ISI）.Hypertension group（36cases）,Hypertension complicated with Insulin resistance group（34cases）.The oral glucose tolerance test and insulin release test were performed in all patients and 30 healthy subjects.Carotid intima-media thickness（IMT） was calculated.Thirty healthy subjects were recruited as control.Correlation between IMT and insulin-sensitivity parameters were respectively obtained using linear regression analysis,and the stepwise regression analysis was used to assess the independent effect of each parameter.Result：IMT was significantly higher in Hypertension complicated with Insulin resistance group than contrast group（P0.01）,IMT was higher in hgpertension complicated with Insulin resisance group than Hypertension group（P0.05）,IMT was significantly higher in Hypertension group than contrast group（P0.05）,IMT was positively correlated with FSI、SBP（r=0.352,0.444,P0.05）,inversely corelated with ISI（r=-0.425,P0.05）.Conclusion： IR were closely relative to carotid IMT in EH patients of elderly patients.