正常糖耐量人群中血压与胰岛素抵抗及胰岛素分泌关系研究

Correlation between blood pressure and insulin resistance and secretion in population with normal glucose tolerance

目的研究血压与胰岛素敏感性和胰岛B细胞功能之间的关系。方法采用多阶段分层整群随机抽样方法对江苏省内人群进行研究,根据口服葡萄糖耐量试验结果选取18岁以上正常糖耐量人群952例,根据血压不同,分为正常血压组、正常高值组、1级高血压组、2级高血压组、3级高血压组。胰岛素敏感性采用ISIM及1/HOMA-IR评价;胰岛B细胞功能采用HOMA-β、InsAUC30/GluAUC30和InsAUC120/GluAUC120评估。结果同正常血压组相比,正常高值组和1、2、3级高血压组的1/HOMA-IR分别下降11.1%、14.8%、24.1%、33.3%(P<0.001),ISIM分别下降10.3%、15.5%、27.6%、37.1%(P<0.001);InsAUC30/GluAUC30指数分别升高11.1%、41.3%、42.9%、101.2%(P<0.001),InsAUC120/GluAUC120分别升高13.2%、46.5%、54.2%、96.9%(P<0.001);5组间的HOMA-β有上升趋势,但差异无统计学意义。处置指数DI(包括基础时相DI0、早时相DI30、总时相DI120)在5组别间均没有明显变化。结论正常糖耐量人群中,随着血压升高,胰岛素敏感性逐渐下降,出现胰岛素抵抗,胰岛素分泌逐渐上升,尚未出现胰岛分泌功能的缺陷。

Objective To determine the correlation between blood pressure and insulin resistance and insula B cell function in population with normal glucose tolerance. Methods We did a population-based study in Jiangsu province using muhistage, stratified, randomized cluster sampling method. 955 consecutive subjects aged 〉 18 years as having normal oral glucose tolerance were enrolled on the basis of oral glucose tolerance test and were further assigned into normotensive group, prehypertension group, grade 1 hypertension group, grade 2 hypertension group and grade 3 hypertension group, respectively, according to grading of blood pressure. Insulin sensitivity was measured by using Matsuda index （ IS!M ） and homeostasis model assessment of insulin resistance （ 1/HOMA-IR ）, whilst insula B cell function was determined by HOMA-13, InsAUC30/GluAUC3o and InsAUCI2o/GluAUC120. Results Prehypertension group,grade 1 hypertension group,grade 2 hypertension group and grade 3 hypertension group yielded a reduction of 11.1% ,14. 8% ,24. 1% and 33.3% in 1/HOMA-IR （ all P 〈 0. 001 ） and a decreased of 10. 3% , 15.5% , 27. 6% and 37.1% in ISIM （ all P 〈 0. 001 ）, respectively, as compared with normotensive group. This was associated with an increase of 11.1% ,41.3% ,42. 9% and 101.2% in InsAUC30/ GluAUC3o （all P 〈 0. 001 ） and the elevation of 13.2% ,46. 5% ,54. 2% and 96.9% in InsAUC120/GluAUC120 （ all P 〈 0. 001 ） ,respectively. All groups were noted as having increased HOMA-13 （ all P 〉 0. 05 ）. Additionally, distinction in the disposition index （ DI ）, including baseline DI （ DI0）, early-phase DI （ Dl30 ） and total-phase DI （ DI120 ）, did not reach statistical significance among groups （ all P 〉 0. 05）. Conclusion Increased blood pressure in population with normal glucose tolerance is correlated with gradual reduction in insulin sensitivity and hence, development of insulin resistence. This may be responsible for progressive increase in insulin secretion, but not impaired insula secretion capacity.