胰岛素抵抗与老年男性高血压和卒中的关系  

Relationship between insulin resistance and hypertension and stroke in elderly men

作　　者：刘玮[1] 赵瑞敏[2] 陈大伟[1] 陈晋文[1] 谢仁厚[1] 李华军[1] 杜文津[1] 张改华[1] 宋东林[1] 

机构地区：[1]空军总医院南楼神经内科,北京100142 [2]空军总医院检验科,北京100142

出　　处：《中国脑血管病杂志》2009年第11期573-576,共4页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨胰岛素抵抗与老年男性高血压和卒中的关系。方法采用前瞻性设计,收集70例脑梗死(脑梗死组)、62例脑出血(脑出血组)、58例非卒中(对照组)老年男性患者的临床资料。每组再根据有无高血压病史进一步分层,3组依次有高血压病史分别为40、42、32例,无高血压病史分别为30、20、26例。清晨空腹取血,分别测定血脂、空腹血糖、空腹胰岛素,计算胰岛素敏感指数。在控制高血压、脂质异常后,应用多元Logistic回归分析卒中与胰岛素抵抗的关系。结果①与对照组比较,脑梗死组和脑出血组三酰甘油、胆固醇、低密度脂蛋白胆固醇、空腹胰岛素水平升高,差异有统计学意义(P<0.05);高密度脂蛋白胆固醇、胰岛素敏感指数水平降低,差异有统计学意义(P<0.05)。②按有无高血压病史进行分层后比较胰岛素抵抗,3组中无论有无高血压病史,脑梗死和脑出血患者的空腹胰岛素及胰岛素敏感指数与对照组比较,差异均有统计学意义(均P<0.05)。高血压合并卒中患者的空腹胰岛素、胰岛素敏感指数与血压正常卒中患者比较,差异有统计学意义(P<0.05)。而3组空腹血糖比较,差异无统计学意义(P>0.05)。③控制了高血压、脂质异常等因素之后,多元Logistic回归分析显示,胰岛素抵抗是卒中的独立危险因素(P=0.010,OR=1.495,95%CI:1.102～2.028)。结论高血压可能通过增加胰岛素抵抗而增加卒中发生的风险。胰岛素抵抗可能是老年男性卒中发生的独立危险因素。Objective To investigate the relationship between insulin resistance and hypertension and stroke in elderly men. Methods The clinical data of 70 elderly male patients with cerebral infarction （cerebral infarction group） , 62 patients with intracerebral hemorrhage （intraeerebral hemorrhage group） , and 58 non-stroked patients （control group） were collected. Each group was further stratified according to whether they had a history of hypertension or not. The patients with the history of hypertension in the 3 groups were 40, 42, and 32 cases, respectively, and the patients without the history of hypertension were 30, 20, and 26 cases, respectively. The blood lipid, fasting blood glucose and fasting insulin were measured in the early morning, and their insulin sensitivity indexes were computed. The relationship between insulin resistance and stroke was analyzed using multiple Logistic regressions after controlling hypertension and lipid abnormalities. Results①The levels of triglyceride, cholesterol, low-density lipoprotein cholesterol, and fasting insulin were elevated in the cerebral infarction and intracerebral hemorrhage groups as compared to the control group, the difference was statistically significant（P〈0.05） ; the levels of high-density lipoprotein cholesterol and insulin sensitivity indexes were reduced, the difference was also statisti- cally significant（P〈0.05）.②The comparison of insulin resistance after the stratification according to with or without the history of hypertension, the thsting insulin and insulin sensitivity indexes in patients with cerebral infarction and intracerebral hemorrhage were significant different as compared to the control group no matter whether they had or not histoU of hypertension in the 3 groups. （P 〈0.05 all）. There were no signifieant differences in comparison of fasting blood glucose among the three groups （ P 〉 0.05 ）.③After controlling the factors such as hypertension and lipid abnormalities, the muhiple Logistic regression analy

关 键 词：卒中 高血压 老年人 胰岛素 药物拮抗作用 因果律 

分 类 号：R587.1[医药卫生—内分泌] R544.1[医药卫生—内科学] R743.3[医药卫生—临床医学]