1193例住院高血压病患者胰岛素分泌和敏感性情况

目的用口服葡萄糖耐量试验中各点血糖和胰岛素的值来计算反映胰岛素敏感性及β细胞功能的参数,回顾性研究住院高血压病人糖代谢情况。方法根据WHO和美国糖尿病协会标准计算血糖分布情况,去除新诊断的糖尿病病人后,分成正常血糖(NGT)、单纯性空腹血糖升高(IFG)、单纯性餐后血糖升高(IGT)和空腹、餐后血糖均升高(IFG,／IGT)组进行比较。再分别以口服75g葡萄糖后30min或60min血糖正常值为标准对NGT组和IGT组进行分组。用HOMA-IR和Composite胰岛素敏感性指数(ISI)计算胰岛素敏感性,HOMA-B和△I／AG计算β细胞功能。结果1193例住院的原发性高血压病人中,新诊断的糖尿病病人为11．1％,其中57．9％仅有餐后血糖升高。IGT、和IFG／ICT组的HOMA-IR高于NGT组,Composite ISI和AI／AG低于NGT组。无论是否30min或60min血糖升高,IGT组的Composite ISI均低于30min和60min血糖正常的NGT组。30min和(或)60min血糖升高的NGT组△I／AG低于30min和60min血糖正常的NGT组。结论IGT或IFG／IGT的高血压患者同时存在空腹和总体胰岛素敏感性的下降和糖负荷后早期β细胞分泌功能的受损。30min和(或)60min血糖升高的NGT高血压病人存在糖负荷后早期β细胞分泌功能的受损。

Insulin secretion and insulin sensitivity in 1193 inpatients with essential hypertension

OBJECTIVE: To evaluate the metabolic profiles of insulin secretion and insulin sensitivity in different categories of nondiabetic patients with essential hypertension, we made a retrospecting study in our hospital. METHODS: According to the criteria of WHO and ADA, we calculated the distribution of plasma glucose levels during a 75 g oral glucose tolerance test (OGTT). Nondiabetic subjects with hypertension were classified into the following four groups: (1) normal glucose tolerance (NGT) with fasting plasma glucose (FPG) < 6.1 mmol/L and 2h-plasma glucose (2hPG) < 7.8 mmol/L, (2) Isolate impaired fasting glucose (IFG) with FPG 6.1-7 mmol/L and 2hPG < 7.8 mmol/L, (3) Isolate impaired glucose tolerance (IGT) with FPG < 6.1 mmol/L and 2hBG 7.8-11.1 mmol/L, (4) impaired fasting glucose and impaired glucose tolerance (IFG/IGT) with FPG 6.1-7 mmol/L and 2hBG 7.8-11.1 mmol/L. Then we divided the groups of NGT and IGT based on the normal 30 or 60 minute plasma glucose level during OGTT respectively. 30 minute plasma glucose level < 11.1 mmol/L and 60 minute plasma glucose level < 10.5 mmol/L were considered to be normal. HOMA-IR (insulin resistance) and composite ISI (insulin sensitivity index) were used to estimate insulin resistance and HOMA-beta and DeltaI/DeltaG index to estimate insulin secretion. RESULTS: 11.1% of the 1193 subjects were newly diagnosed diabetic patients, in whom 57.9% had isolated postchallenge hyperglycemia only. In the IGT and IFG/IGT groups, HOMA-IR were significantly higher than that in the NGT group, whereas composite ISI and DeltaI/DeltaG were significantly lower than that in the NGT group. Whether 30 or 60 minute plasma glucose level was high or not, composite ISI in IGT group was significantly lower than that in the NGT group. In the NGT group, DeltaI/DeltaG in subjects with high 30 or and 60 minute plasma glucose level was significantly lower than that in subjects with normal 30 and 60 minute plasma glucose level. CONCLUSIONS: Subjects with IGT or IFG/IGT have both impaired insulin sensitivity and insulin secretion. In the NGT group, subjects with high 30 or/and 60 minute plasma glucose level have impaired beta-cell function.