胰岛素抵抗与心血管危险因素聚集的流行病学研究

目的 研究人群中胰岛素抵抗与心血管危险因素聚集的关系。方法 按照随机抽样的原则,在江苏省邳州市的农村共调查35－59岁的常住居民1196人,其中男性533人,女性663人,平均年龄为46．7岁。应用单克隆抗体为基础的酶联免疫吸附试验方法检测空腹真胰岛素,采用HOMA指数作为胰岛素抵抗的指标。应用Spearman相关、偏相关分析以及多因素非条件Logistic回归等统计分析方法研究胰岛素抵抗与高血压、超重、中心性肥胖、血脂紊乱及心血管危险因素聚集的关系。结果 真胰岛素与HOMA指数的中位数（四分位间距）分别为4．89（3．02－7．09）mIU/L及0．98（0．57－1．44）,在性别间分布均为女性高于男性（P＜0．01）。HOMA指数与心血管危险因素数目的相关系数为0．290（P＜0．01）。在调整了年龄、性别、体重指数与腰围变量后,HOMA指数与危险因素数目的偏相关系数为0．1776（P＜0．01）。非条件多元逐步Logistic回归分析显示,胰岛素抵抗独立于年龄、性别、体重指数、腰围与心血管危险因素聚集相关,其OR值（95％可信限）为1．250（1．089－1．434）。结论 胰岛素抵抗为心血管危险因素聚集的中心环节,非酯化脂肪酸的代谢异常引起碳水化合物与血脂代谢紊乱可能是胰岛素抵抗导致心血管危险因素聚集的机制。

Relationship between insulin resistance and cardiovascular risk factors clustering: an epidemiological study

OBJECTIVE: To study the relationship between insulin resistance and cardiovascular risk factor clustering. METHODS: The height, body weight, waist circumference, and hip circumference were measured, and fasting venous blood was drawn among 1 196 rural residents, 533 males (44.57%) and 663 females (55.43%), aged 35 approximately 59 with the average age of 46.69, in Pizhou City, Jiangsu Province, selected by random sampling. Fasting serum true insulin (TI) was determined by ELISA. Blood lipids were measured by completely automatic biochemical analyzer. Homeostasis model assessment (HOMA) index was calculated and used as the indicator to evaluate insulin resistance. The statistic methods, such as Spearman correlation, partial correlation and multivariate Logistic regression were used to study the relationship between insulin resistance and hypertension, overweight, visceral obesity, dyslipidemia and cardiovascular risk factors clustering. RESULTS: The median (Q(R)) of TI and HOMA index were 4.89 (3.02 approximately 7.09) mIU/L and 0.98 (0.57 approximately 1.44) respectively, and TI and HOMA index of the female subjects were significantly higher than those of the male subjects (P < 0.01). The correlation coefficient between HOMA index and cardiovascular risk factors number was 0.290 (P < 0.01) by Spearman correlation analysis and 0.177 6 (P < 0.01) by partial correlation analysis after adjustment by age, sex, body mass index and waist circumference respectively. The results of non-conditional multivariate stepwise Logistic regression indicated that insulin resistance associated with cardiovascular risk factors aggregation and was independent of age, sex, body mass index and waist circumference, and the odds ratio (95% CI) was 1.250 (1.089 approximately 1.434). CONCLUSION: Insulin resistance may be a common pathogenetic mechanism of cardiovascular risk factor dustering.