老年原发性高血压患者胰岛素抵抗与颈动脉粥样硬化的关系

Relationship between insulin resistance and carotid atherosclerosis in elderly patients with essential hypertension

目的探讨老年原发性高血压(EH)患者胰岛素抵抗(IR)与颈动脉粥样硬化形成的关系。方法老年EH患者87例按胰岛素抵抗指数(HOMA-IR)分为EH伴IR组41例和EH无IR组46例。应用胰岛素敏感指数(ISI)评估IR程度,高分辨率B型超声测定颈动脉参数。结果 EH伴IR组患者的空腹血胰岛素水平、胰岛β细胞功能和体质量指数高于EH无IR组(P<0.05),而ISI低于EH无IR组(P<0.05)。EH伴IR组颈动脉搏动指数(PI)、阻力指数(RI)、斑块检出率、斑块积分、颈总动脉内膜-中膜厚度(IMT)显著高于EH无IR组(P<0.05),而颈动脉血流速度和颈动脉可变系数显著低于EH无IR组(P<0.05)。HOMA-IR与IMT、PI、RI呈正相关(r=0.36,0.31,0.33;P<0.01),与颈动脉可变系数、舒张期平均血流速度/收缩期平均血流速度呈负相关(r=-0.28,-0.29;P<0.01)。结论老年EH伴IR患者颈动脉血流动力学及血管壁顺应性变化与颈动脉粥样硬化形成密切相关。

Objective To investigate the relationship between insulin resistance（IR） and the formation of carotid atherosclerosis in elderly patients with essential hypertension（EH）.Methods Eighty-seven patients with EH were divided into EH with IR group（n=41） and EH without IR group（n=46） according to the insulin resistance index（HOMA-IR）.The degree of IR was assessed by insulin sensitivity index（ISI）,and the parameters of carotid were measured by high resolution B type ultrasound.Results The level of fasting insulin,the function of beta cell of islet,and body mass index in the EH with IR group were higher than those in the EH without IR group（P0.05）,but ISI in the EH with IR group was lower than that in the EH without IR group（P0.05）.Carotid artery pulsatility index（PI）,resistent index（RI）,plaque detection rate,plaque score,and common carotid artery iniima-media thieknes（IMT） in the EH with IR group were significantly higher than those in the EH without IR group（P0.05）,while carotid blood velocity and cross-sectional dispensability coefficient in the EH with IR group were significantly lower than those in the EH without IR group（P0.05）.HOMA-IR was positively correlated with IMT,PI and RI（r=0.36,0.31,0.33;P0.01）,while HOMA-IR was negatively correlated with cross-sectional dispensability coefficient and the ratio of diastolic mean blood flow velocity and systolic mean blood flow velocity（r=-0.28,-0.29;P0.01）.Conclusion Carotid artery haemodynamics and vessel wall compliance change may be closely related to the formation of carotid atherosclerosis in elderly patients EH and IR.