老年高血压伴糖耐量减低患者胰岛素抵抗指数对血压变异率及昼夜节律的影响

INFLUENCE OF HOMEOSTASIS MODEL ASSESSMENT OF INSULIN RESISTANCE ON BLOOD PRESSURE VARIABILITY AND CIRCADIAN RHYTHM IN PATIENTS WITH ELDERLY HYPERTENSION AND IMPAIRED GLUCOSE TOLERANCE

目的探讨老年高血压伴糖耐量减低(IGT)患者胰岛素抵抗指数(HOMA-IR)对血压变异率(BPV)及血压昼夜节律的影响。方法选取2020年10月—2021年9月于青岛市妇女儿童医院就诊的老年高血压伴IGT患者106例,以HOMA-IR的第50百分位数(P_(50))为分界线,将受试者分为高IR组和低IR组(各53例),对比两组一般情况、血糖相关指标、HOMA-IR以及动态血压监测结果,并分析HOMA-IR与BPV的相关性。结果高IR组患者空腹胰岛素、HOMA-IR显著高于低IR组(t=-10.905、-13.416,P<0.05);高IR组患者昼间、夜间、24 h收缩压标准差,以及昼间、夜间、24 h收缩压变异系数均高于低IR组(t=-4.180~-2.356,P<0.05);高IR组患者异常血压昼夜节律构成比高于低IR组(χ^(2)=4.330,P<0.05);相关性分析显示,所有患者HOMA-IR与昼间、夜间、24 h收缩压标准差,昼间、夜间、24 h收缩压变异系数均呈正相关(r=0.202~0.328,P<0.05)。结论老年高血压伴IGT患者HOMA-IR与BPV增高存在相关性,胰岛素抵抗可能是老年高血压伴IGT患者BPV及血压昼夜节律紊乱的危险因素。

Objective To investigate the influence of homeostasis model assessment of insulin resistance(HOMA-IR)on blood pressure variation(BPV)and circadian rhythm in patients with elderly hypertension and impaired glucose tolerance(IGT).Methods A total of 106 patients with elderly hypertension and IGT who attended Qingdao Women and Children’s Hospital from October 2020 to September 2021 were enrolled,and according to the 50th percentile(P_(50))of HOMA-IR,the patients were divided into high insulin resistance(IR)group and low IR group,with 53 patients in each group.The two groups were compared in terms of general status,blood glucose indicators,HOMA-IR,and ambulatory blood pressure monitoring results,and the correlation between HOMA-IR and BPV was analyzed.Results The high IR group had significantly higher fasting insulin and HOMA-IR than the low IR group(t=-10.905,-13.416,P<0.05).Compared with the low IR group,the high IR group had significantly higher standard deviations of daytime,nighttime,and 24 h systolic blood pressure and coefficients of daytime,nighttime,and 24 h systolic blood pressure variation(t=-4.180--2.356,P<0.05).Compared with the low IR group,the high IR group had a significantly higher proportion of patients with abnormal circadian rhythm of blood pressure(χ^(2)=4.330,P<0.05).The correlation analysis showed that HOMA-IR was positively correlated with the standard deviation of daytime,nighttime,and 24 h systolic blood pressure and the coefficient of daytime,nighttime,and 24 h systolic blood pressure variation(r=0.202-0.328,P<0.05).Conclusion HOMA-IR is positively correlated with BPV in patients with elderly hypertension and IGT,and IR might be a risk factor for BPV and circadian rhythm disorders in such patients.