不同糖耐量的老年高血压患者颈动脉粥样硬化与胰岛素抵抗及炎性因子的相关性

目的探讨不同糖耐量老年高血压患者颈动脉粥样硬化与胰岛素抵抗(IR)及炎性因子的相关性。方法 94例老年高血压患者进行葡萄糖耐量实验(OGTT),根据OGTT结果分为糖耐量正常组(NGT组)30例、糖耐量异常组(IGT组)32例、2型糖尿病组(DM组)32例,同时选取30例健康体检者为对照组。4组患者均行超声检查颈动脉内膜-中层厚度(IMT),测定空腹血糖(FPG)、空腹胰岛素(FIns)、血脂、hs-CRP及TNF-α等指标,采用自我平衡模型分析法(HOMA)计算胰岛素抵抗指数(HOMA-IR)。结果 HOMA-IR、hs-CRP、TNF-α及IMT等指标DM组明显高于其余3组,IGT组明显高于NGT组及对照组,NGT组明显高于对照组(P<0.01),相关性分析显示IMT与HOMA-IR、hs-CRP、TNF-α水平呈正相关(r分别为0.406、0.420、0.396,P<0.05)。结论在老年高血压患者中存在IR和炎性反应,老年高血压患者的HOMA-IR、hs-CRP、TNF-α与颈动脉IMT密切相关。

Relationship between insulin resistance,inflammation factors and carotid atherosclerosis in elderly hypertensive patients with different glucose tolerance

Objective To explore the relationship between insulin resistance(IR),inflammation factors and carotid atherosclerosis in elderly hypertensive patients with different glucose tolerance.Methods 94 elderly hypertensive patients were examined for fasting and 2-hour postprandial plasma glucose by the 75g OGTT test.According to the test,94 patients were divided into three groups,30 patients in normal glucose tolerance(NGT) group,32 ones in impaired glucose tolerance(IGT) group,and 32 ones in diabetes mellitus(DM) group.In addition,there was 30 healthy people in normal control group.All patients underwent carotid ultrasound intima-media thickness(IMT).The level of fasting plasma glucose,fasting insulin,blood lipids,hs-CRP and TNF-α were analyzed,respectively.Homeostasis model assessment(HOMA) index was used for quantitative analysis of insulin resistance index(HOMA-IR).Results The level of HOMA-IR,hs-CRP,TNF-α and IMT in DM group were significantly higher than those in other three groups,which in IGT group were significantly higher than those in NGT group or control group,and those in NGT group were significantly higher than those in control group.The differences among them were statistically significant(P<0.01).Correlation analysis result showed that IMT was positively correlated with the level of IRI,hs-CRP or TNF-α(r=0.406,0.420 and 0.396,P<0.05).Conclusion Insulin resistance and inflammatory activity is found in elderly hypertensive patients.The levels of HOMA-IR,hs-CRP and TNF-α are closely correlated with carotid IMT in elderly hypertensive patients.