老年高血压合并2型糖尿病患者餐后血糖与血压关系的研究

目的探讨老年高血压合并2型糖尿病患者，餐后血糖与炎症因子C-反应蛋白、脉压、昼夜血压的关系及临床意义。方法选择单纯高血压、高血压合并2型糖尿病餐后高血糖患者及健康体检者各30例，均测定空腹血糖（FPG）、餐后2h血糖（2hPG）、空腹血浆胰岛素（FINs）、糖化血红蛋白（HbAlC）、血清C-反应蛋白（CRP），计算胰岛抵抗指数（IRI），高血压患者行动态血压监测（ABPM）。对各组的CRP、糖代谢指标、动态血压参数等进行统计学分析，并比较高血压合并2型糖尿病餐后高血糖患者治疗前后各项指标。结果高血压合并糖尿病组FPG、2hPG、FINS、IRI、HbAlC及CRP各指标与单纯高血压组及正常对照组比较差异有统计学意义（P〈0．05），单纯高血压组FINS、IRI及CRP高于正常对照组，差异有统计学意义（P〈0．05）；与单纯高血压患者相比，高血压合并糖尿病餐后高血糖组患者脉压（PP）增大，非杓型比率高，差异有统计学意义（P〈0．05）；高血压合并糖尿病餐后高血糖患者治疗后PP、非杓型比率下降，与治疗前比较差异有统计学意义（P〈0．05）。结论高血压与糖尿病同样存在胰岛素抵抗，高血压合并糖尿病患者，餐后血糖与CRP水平、PP、血压昼夜节律异常相关，餐后血糖的控制可能有助于夜间杓型血压的恢复，延缓动脉粥样硬化的进程。

Correlation between postprandial plasma glucose level and blood pressure in elderly hypertensive patients accompanied with type 2 diabetes mellitus

Objective To explore the relation and clinical significance of postprandial glucose level with inflammation factor C-reactive protein, pulse pressure and the circadian blood pressure in elderly hypertensive patients with type 2 diabetes. Methods Thirty patients with simple hypertension, 30 patients with both hypertension and type 2 diabetes mellitus of postprandial hyperglycemia and 30 healthy subjects were selected. Fasting plasma glucose （FPG）, 2h postprandial plasma glucose （2 h PG）, fasting plasma insulin （FINS）, glycosylated hemoglobin （HbA1C）, serum C-reactive protein （CRP） of these patients were all examined and the insulin resistance index （IRI） was calculated. Patients with hypertension were detected by ambulatory blood pressure monitoring （ABPM）. Statistic analyses were taken among the three groups on CLIP, glycometabolism index and ambulatory blood pressure index and other parameters. The hypertensive patients with type 2 diabetes were treated and their parameters before and after the treatment were further analyzed. Results The levels of FPG, 2hPG, FINS, IRI, HbA1C, CRP in hypertensive patients with type 2 diabetes mellitus of postprandial hyperglycemia group were of significant difference from the simple hypertension group and the control group （P〈0.05）. There was a significant difference between the simple hypertension group and the control group in FINS, IRI, CRP levels （P〈0.05）. Compared with the simple hypertension group, the pulse pressures （PP） and non-dipper ratio were higher in hypertensive patients accompanied with type 2 diabetes mellitus, and the difference was significant （P 〈 0.05）. Statistical differences of PP and non-dipper ratio before and after treatment were also found significant in the hypertensive patients with type 2 diabetes mellitus of postprandial hyperglycemia （P〈0.05）. Conclusion Insulin resistance exists both in hypertension and in diabetes mellitus. Postprandial glucose level in hypertension patients accompanied with diabetes mellitus was associated with the level of CRP, PP and abnormal circadian rhythm of blood pressure. The control of postprandial glucose level may contribute to nocturnal blood pressure recovery, delay the process of atherosclerosis.