高血压患者胰岛素抵抗与代谢综合征及心血管事件的发生情况的相关性分析

目的:分析高血压患者胰岛素抵抗与代谢综合征及心血管事件的发生情况及其影响因素。方法:选择2014年6月至2017年9月解放军113医院及河南大学附属医院收治的382例高血压患者,根据是否存在胰岛素抵抗将其分为单纯高血压(对照组,n=212)和高血压伴胰岛素抵抗(实验组,n=170)。根据国际糖尿病联盟代谢综合征的相关定义将患者分为A组(代谢综合征,n=202)和B组(非代谢综合征,n=180)。比较患者的身高、体质量并计算其体质量指数(BMI)、收缩压(SBP)、舒张压(DBP),检测两组受试者空腹血糖(FPG)、三酰甘油(TG)、总胆固醇(TC)、肌酐(SCr)、血尿素氮(BUN)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、采用酶联免疫法测定高敏C反应蛋白(hs-CRP)、脂联素(APN)、空腹胰岛素(FINS)水平。随访1年并记录患者心血管事件发生情况。结果:实验组血清APN、FPG、FINS、HOMA-IR、hs-CRP水平与对照组比较,差异具有统计学意义(P0.05)。A组患者SBP、DBP、BUN、APN、FPG、HOMA-IR、hs-CRP水平明显高于B组,HDL-C水平明显低于B组,差异具有统计学意义(P0.05)。BUN、HDL-C、HOMA-IR、hs-CRP水平升高为高血压患者发生代谢综合征独立危险因素(P0.05)。随访1年后,对照组患者发生心血管事件72例,实验组144例。进一步采用多因素Logistic回归分析显示,血清TG、HDL-C、HOMA-IR、hs-CRP水平升高为高血压患者发生心血管事件的危险因素(P0.05)。结论:高血压伴胰岛素抵抗患者其胰岛素抵抗程度高于单纯高血压患者;胰岛素抵抗与代谢综合征显著相关,为高血压患者发生心血管事件的危险因素。

Analysis of Metabolic Syndrome and Cardiovascular events in Patients with Hypertension and Insulin Resistance

ABSTRACT Objective: To analysis the metabolic syndrome and cardiovascular events in patients with hypertension and insulin resistance, and to explore its correlation. Methods: The clinical datas of 382 patients with hypertension adopted by our hospital from June 2014 to September 2017 were selected. According to the existence of insulin resistance, the patients were divided into two groups: simple hypertension (the simple group, n=212) and hypertension with insulin resistance (the experimental group, n=170). According to the relevant definition of metabolic syndrome of the International Diabetes Alliance, the patients were divided into two groups: group A (metabolic syndrome n=202) and group B (non-metabolic syndrome n=180). We recorded the height and body weight of patients in each group,and we caculated the body mass index (BMI), SBP and DBP. Fasting blood glucose (FPG), triacylglycerol (TG), total cholesterol (TC), creatinine (SCr), blood urea nitrogen (BUN), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol (LDL-C) were measured. The levels of hypersensitive C reactive protein (hs-CRP) and adiponectin (APN), fasting insulin (FINS) were measured by enzyme linked immunosorbent assay (Elisa). Patients were followed up for 1 year and cardiovascular events were recorded. Results: The level of serum APN, FPG, FINS, HOMA-IR, hs-CRP in the experimental group were significantly higher than that in the control group, the difference was statistically significant(P<0.05). The level of SBP, DBP, BUN, APN, FPG, HOMA-IR, hs-CRP in group A were significantly higher than that in group B, and the level of HDL-C in group A was significantly lower than that in group B. The differences were statistically significant (P<0.05). BUN HDL-C HOMA-IR and hs-CRP were independent risk factors for metabolic syndrome (P<0.05). After 1 year follow-up, 72 cases of cardiovascular events occurred in the simple group and 144 cases in the experimental group. Multivariate Logistic regression analysis showed that serum TG, HDL-C, HOMA-IR, hs-CRP level were risk factors for cardiovascular events in patients with hypertension (P<0.05). Conclusion: The degree of insulin resistance in patients with hypertension and insulin resistance is higher than that in patients with simple hypertension. Insulin resistance is significantly associated with metabolic syndrome and Insulin resistance is a risk factor for cardiovascular events in hypertensive patients.