老年高血压病糖代谢异常及合并心血管病危险分析

目的 观察无糖尿病史的老年高血压病糖代谢异常的发生情况、临床特点及其对心血管损害的影响.方法 选取119例无糖尿病史的原发性高血压患者为观察组,同时选取31例无糖尿病和高血压病史的人群为对照组,比较两组的吸烟史、体重指数(BMI)、血糖、胰岛素抵抗指数(IRI)、胰岛素敏感性指数(ISI)等指标;根据葡萄糖耐量试验(OGTT)将高血压病人群分为正常糖耐量(NGT)组、糖调节受损(IGR)组和糖尿病(DM)组,比较3组的BMI、血糖、血脂、血压、尿白蛋白/肌酐比值、颈动脉内中膜厚度(IMT)、左室质量指数(LVMI )和左室射血分数(LVEF).结果 ①高血压组的吸烟史、BMI、IRI、ISI、糖负荷后2 h血糖(PPG)、空腹胰岛素(FIN)、糖负荷后2 h胰岛素(PIN)、甘油三酯(TG)、高密度脂蛋白(HDL)高于对照组(P<0.05);且IRI分别与BMI、SBP、DBP、TG、HDL存在相关关系;②老年高血压病患者中DM患病率为24.4%,IGR患病率为38.6%,总的糖代谢异常患病率为63%.③IGR组、DM组的空腹血糖(FPG)、PPG、PIN、IRI、ISI、BMI、TG、HDL、低密度脂蛋白(LDL)和SBP分别与NGT组比较差异有统计学意义(P<0.05);④IGR组、DM组的斑块发生率和LVEF均高于NGT组(P<0.05).结论 老年高血压病患者存在明显的糖耐量异常,有必要对老年高血压病患者进行OGTT,做到早期发现早期干预,预防心血管并发症.

Glucose Metabolism in Elderly Patients with Essential Hypertension and Risk of Cardiovascular Diseases

Objective To investigate the characteristics of glucose metabolism in elderly patients with essential hypertension and its association with cardiovascular diseases. Methods One hundred and nineteen elderly patients with essential hypertension and no diagnosed diabetes mellitus were recruited. Thirty-one elderly patients with neither diagnosed diabetes mellitus nor essential hypertension served as controls. Data about the history of smoking, BMI, IRI and ISI were collected from the participants. According to oral glucose tolerance test (OGTT), the patients with essential hypertension were divided into normal glucose tolerance group (NGT), impaired glucose regulation group (IGR) and diabetes mellitus group (DM). The BMI, FPG, PPG, TG, TC, LDL, HDL, SBP, DBP, IMT, LVMI and LVEF were compared between the groups. Results The patients with essential hypertension had significantly higher smoking rate and higher BMI, IRI, ISI, PPG, FIN, PIN, Cr, UA, TG and HDL than the controls (P<0.05). IRI was correlated with BMI, SBP, DBP, TG and HDL. DM, IGR and abnormal glucose metabolism were identified in 24.4%, 38.6%, and 63% of the elderly patients with essential hypertension patients, respectively. The patients in the IGR group and DM group had significantly higher FPG, PPG, PIN, IRI, ISI, BMI, Cr, TG, HDL, LDL and SBP than those in the NGT group (P<0.05). The incidence of plaque and LVEF in the patients with IGR and DM were higher than in the patients with normal glucose tolerance (P<0.05). Conclusion Elderly patients with essential hypertension have abnormalities in glucose metabolism. OGTT should be offered to the elderly patients with essential hypertension as a measure to detect DM and prevent cardiovascular diseases.