胰岛素抵抗及2型糖尿病对原发性高血压患者血压昼夜节律及动脉硬化的影响

The Effect of Insulin Resistance and Type 2 Diabetes Mellitus on the Circadian Rhythm of Blood Pressure and Atherosclerosis in Patients with Essential Hypertension

目的研究原发性高血压(EH)、EH合并胰岛素抵抗(IR)及EH合并2型糖尿病(T2DM)对患者血压昼夜节律及动脉血管硬化的影响。方法选取2015年1月至2017年1月四川省人民医院EH患者150例,按是否合并IR及T2DM,分为对照组、IR组及T2DM组,每组各50例。治疗后,通过比较3组间血压昼夜节律及其变异性和检测颈动脉硬化检出率,以有无颈动脉硬化为因变量,进行Logistic回归分析。结果 T2DM组首诊3月后,24h收缩压和舒张压、24h收缩压标准差、24h收缩压和舒张压变异系数、白昼收缩压和舒张压、夜间收缩压和舒张压、非杓型节律的比例及颈动脉硬化检出率均高于IR组和对照组(P<0.05),且T2DM组夜间收缩压和舒张压下降百分率均较IR组及对照组明显降低(P<0.05)。IR组首诊3月后,24h收缩压、24h收缩压和舒张压标准差、24h收缩压变异系数、白昼收缩压及夜间舒张压均高于对照组(P<0.05),夜间收缩压和舒张压下降百分率较对照组明显降低(P<0.05)。Logistic回归分析显示,T2DM是颈动脉硬化的危险因素(OR=2.175),夜间舒张压下降率是颈动脉硬化的保护因素(OR=0.913)。结论 EH患者合并T2DM或IR均能够明显增加血压昼夜节律异常的发生,T2DM是EH患者发生颈动脉硬化的独立危险因素。

Objective To explore the effect of insulin resistance(IR)and type2diabetes mellitus(T2DM)on the circadian rhythm of blood pressure and atherosclerosis in patients with essential hypertension(EH).Methods A total of150EH patients treated in Sichuan Provincial People's Hospital from January of2015to January of2017were selected in the study and divided into the control group,IR group and T2DM group according to whether those EH patients had IR and T2DM or not,and each group included50cases.The circadian rhythm of blood pressure and its variability and the incidence of carotid atherosclerosis were recorded and compared after3months of treatment among the three groups.The Logistic regression analysis was conducted with the carotid atherosclerosis as the dependent variable.Results The T2DM group had higher levels than the IR group and control group after3months of treatment in the24h systolic blood pressure(24h SBP),24h diastolic blood pressure(24h DBP),standard deviation of the24h SBP,variation coefficients of24h SBP(SVC)and24h DBP(DVC),daytime SBP and DBP,nighttime SBP and DBP,ratio of non-dipper rhythm,incidence of carotid atherosclerosis and decreasing percentage of nighttime DBP and SBP,and the differences were statistically significant(P<0.05).The IR group had higher levels than the control group after3months of treatment in the24h SBP,standard deviation of24h SBP and24h DBP,SVC,daytime SBP,nighttime DBP,and decreasing percentage of nighttime DBP and SBP,and the differences were statistically significant(P<0.05).The results of the Logistic regression analysis showed that T2DM was a risk factor(OR=2.175)and the decreasing percentage of nighttime DBP was a protective factor for carotid atherosclerosis(OR=0.913).Conclusion Both T2DM and IR can significantly increase the incidence of abnormal circadian rhythm of blood pressure in EH patients and T2DM is an independent risk factor for carotid atheroscleros