老年女性高血压患者胰岛素抵抗与颈动脉粥样硬化相关性研究

目的研究老年女性高血压患者颈动脉粥样硬化与胰岛素抵抗的相关性。方法纳入高血压患者218例,分为4组:老年女性组、非老年女性组、老年男性组、非老年男性组。将老年女性分为单纯高血压亚组(EH亚组)和高血压合并糖尿病亚组(EH合并DM亚组)。所有病例均行颈动脉超声检查颈动脉内膜中层厚度(IMT),测定空腹血糖和胰岛素、动态血压、三酰甘油、胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇,体质量指数(BMI),计算稳态模式评估法的胰岛素抵抗指数(HOMA-IR),对颈动脉IMT异常的老年女性,采用直线回归分析方法与心血管危险因素做相关分析。结果老年高血压女性患者IMT与HOMA-IR、BMI和空腹血糖呈正相关;与非老年女性组比较,老年女性组IMT、FPG、血脂、BMI、HOMA-IR显著高于非老年女性组(P<0.05)。与EH亚组比较,EH合并DM亚组FPG、FINS、hs-CRP、IMT、HOMA-IR显著升高,差异有统计学意义(P<0.05)。结论老年女性高血压和糖尿病同时存在可加速动脉粥样硬化的进展,而且与高血压患者胰岛素抵抗的发生、发展密切相关。

Relationship between insulin resistance and carotid atherosclerosis in elderly female with hypertension

Objective To investigate relationship between insulin resistance and carotid atherosclerosis in elderly female patients with hypertension. Methods Consecutive 218 patients with hypertension were classified into four groups ： elderly female group, non-elderly female group, elderly male group and non-elderly male group. The elderly female group were divided into essential hypertension subgroup （ EH subgroup） and essential hypertension complicated with diabetes mellitus subgroup （EH＆DM subgroup）. Carotid intima media thickness（IMT） were calculated in all patients, fasting serum insulin/fasting serum glucose, ambulatory blood pressure, triglyceride （TG）, plasma cholesterol, high density lipoprotein cholesterol, low density fipoprotein cholesterol and body mass index （BMI） were measured in all groups,insulin resistance index（HOMA-IR） were calculated. Correlation between carotid IMT,eklerly female and risk factor of angiocardiopathy were obtained using linear regression analysis. Results IMT was positively correlated with HOMA-IR, BMI and fasting serum glucose in elderly female group. The value of IMT, HOMA-IR, FPG, BMI, Blood fat in elderly female group were significantly higher than those of no-elderly female group （ P 〈 0.05）. Furthermore, the value of FPG, FINS, hsCRP, IMT, HOMA-IR was increased obviously in EH＆DM subgroup than EH subgroup（ P 〈 0.05 ）. Conclusion The elderly female complicated hypertension and DM could promote the progression of the atherosclerofic, and were closely relative to insulin resistance.