高血压病人颈动脉粥样硬化与胰岛素抵抗关系的探讨

目的　探讨胰岛素抵抗及高胰岛素血症与高血压病人颈动脉粥样硬化的关系。方法　选择原发性高血压病人 84例 ,分成颈动脉粥样硬化组 (CA组 )和颈动脉正常组 (NC组 )。应用高分辨率 B型超声测定颈动脉参数。应用胰岛素敏感指数 (ISI)评估胰岛素抵抗程度。结果　 CA组的胰岛素 (INS)、颈动脉内膜 -中层厚度 (IMT)、粥样硬化斑块积分 (PS)显著高于 NC组 (P<0 .0 5 ) ,CA组的 ISI显著低于 NC组 (P<0 .0 5 )。 IMT与血糖 (SG)、INS呈正相关 (P<0 .0 1) ,IMT与 ISI呈负相关 (P<0 .0 1)。 PS与 SG、INS呈正相关 ,PS与 ISI呈负相关 (P<0 .0 1)。多元逐步回归分析显示 :年龄、SG、ISI、收缩压 (SBP)与 IMT相关性较为密切 ,其标准回归系数分别为 0 .2 2 2、0 .739、- 1.12 5、0 .116。 INS、体重指数(BMI)、脉压 (PP)与 PS相关性较为密切 ,其标准回归系数分别为 0 .5 5 4、- 0 .2 2 1、0 .141。结论　胰岛素抵抗与高血压病人颈动脉内膜 -中层厚度增厚及粥样硬化斑块形成密切相关

Relationship between insulin resistance and carotid atherosclerosis in hypertension

Objective To investigate relationship between insulin resistance (IR) and extracranial carotid atherosclerosis in essential hypertension (EH) patients. Methods All subjects were classified into two groups, which were carotid atherosclerosis group (CA group) and normal carotid group (NC group), respectively. Carotid parameters were assessed with high-resolution B-mode ultrasonography. Insulin sensitivity index (ISI) was used to evaluate insulin (INS) resistance level. Results INS was significantly higher in CA group than NC group (P<0.05). ISI was significantly lower in CA group than NC group (P<0.05). A significant positive relationship between intima-media thickness (IMT) and serum glucose (SG) and INS. ISI was negative association with IMT. A significant positive relationship between plaque score (PS) and SG and INS. ISI was negative association with PS (P<0.01). Stepwise revealed that Age, SG, ISI and systolic blood pressure (SBP) were significant variable associated with IMT, and INS, body mass index (BMI) and pulse pressure (PP) were significant variable associated with PS. Conclusions IR were closely relative to carotid IMT and plaque formation in EH patients.