单纯空腹血糖受损患者胰岛素抵抗和胰岛功能与血压的相关性研究

发布时间：2018-04-17 07:32

本文选题：单纯空腹血糖受损 + 原发性高血压　；参考：《第三军医大学》2015年硕士论文

【摘要】：背景:大量的研究显示,空腹血糖受损(IFG)是预测糖尿病发生风险的独立危险因素,空腹血糖受损(IFG)人群进展为糖尿病的风险明显高于普通人群,是未来发展成糖尿病的庞大候选人群。目前,已涌现出大量有关空腹血糖受损的临床与基础研究,同时有流行病学研究显示,空腹血糖受损(IFG)和糖耐量异常(impaired glucose tolerance,IGT)只有一部分重叠人群,而两者在胰岛素抵抗(insulin resistance,IR)的位点上存在明显不同,因此探索单纯空腹血糖受损(isolated impaired fasting glucose,i-IFG)患者的起病与转归有重要的临床意义。而循证证据显示,40%~50%的原发性高血压患者存在着胰岛素抵抗现象,胰岛素抵抗往往又带来血糖的异常,近年来,原发性高血压病(Essential Hypertension,EH)与糖尿病前期及2型糖尿病是否存在共同的病理生理基础是国内外研究的重点。虽然有部分关于原发性高血压病的研究发现血管紧张素受体拮抗剂可使2型糖尿病的发生风险降低,但是在这些研究中并没有明确说明是不同降压水平还是降压药物自身带来的临床获益,而对单纯空腹血糖受损(i-IFG)合并原发性高血压(EH)患者的临床转归和干预研究更少。因此探索阻止或减少单纯空腹血糖受损(i-IFG)合并原发性高血压(EH)患者向糖尿病转变的方法,观察高血压这一危险因素对单纯空腹血糖受损(i-IFG)临床转归的影响,以及观察是降压药物本身使血糖获益还是血压水平下降带来的异常血糖的改善,达到有效地预防或延缓2型糖尿病的发生,具有重要的研究价值和意义。目的:观察单纯空腹血糖受损患者的胰岛素抵抗和胰岛功能与血压的相关性,研究血压降低后,单纯空腹血糖受损合并原发性高血压病的患者的胰岛功能和胰岛素抵抗的变化。研究设计与方法:本研究分两部分实验进行:第一部分:选取既往无糖尿病病史的单纯空腹血糖受损患者180例,测定血压后分为原发性高血压组(n=94例)、血压正常组(n=86例),两组均给予健康的生活方式指导,原发性高血压组的患者均给予临床常用降压治疗(血管紧张素受体拮抗剂或钙离子通道阻滞剂),对比分析治疗6个月前后两组患者的空腹血糖(fpg)、空腹胰岛素(fins)、ogtt试验后2h血糖(2hpg)、ogtt试验后2h胰岛素(2hins)、糖化血红蛋白(glycosylatedhemoglobin,hba1c),并计算胰岛素抵抗指数(homa-ir,thehomeostasismodelofinsulinresistance)的变化情况。第二部分:选取原发性高血压伴单纯空腹血糖异常患者244例,随机(124:120)分别给予50mg/d~100mg/d的氯沙坦钾片或2.5mg/d~5.0mg/d的苯磺酸左旋氨氯地平片强化降压治疗3年,并同时给予生活方式干预指导,在血压(bloodpressure,bp)达标(bp130/80mmhg)的情况下,对比治疗前后空腹血糖(fpg)、空腹胰岛素(fins)、ogtt试验后2h血糖(2hpg)、ogtt试验后2h胰岛素(2hins)、糖化血红蛋白(hba1c)及胰岛素敏感指数(insulinsensitivityindex,isi)的变化情况。结果:第一部分实验结果:与血压正常组相比,基线时原发性高血压组患者的空腹胰岛素、餐后2小时胰岛素及胰岛素抵抗指数homa-ir升高较明显,两组差异具有显著性(p0.5),门诊随访6个月时,高血压组fins、2hins、homa-ir明显降低(p0.05),其中有66例原发性高血压患者的血压下降达标(即bp130/80mmhg),20例原发性高血压患者的血压下降没有达标,原发性高血压达标亚组的fins、2hins、homa-ir降低均比原发性高血压未达标亚组明显(p0.05);血压正常组患者的fins、2hins及homa-ir与基线比较无明显变化(p0.05),两组间新发糖尿病的发生率无显著差异。第二部分实验结果:2组治疗后血压均较治疗前明显下降(p0.05),治疗12个月后氯沙坦钾组fins、2hins水平下降,isi较治疗前明显改善(p0.05),与苯磺酸左旋氨氯地平组比较,差异具有统计学意义(p0.05),治疗24个月、36个月后两组fins、2hins均下降明显,isi也改善明显,与治疗前的指标对比差异具有显著性(p0.05),组间无差别(p0.05),两组间新发糖尿病无显著差异。结论:第一部分:单纯空腹血糖异常伴原发性高血压患者胰岛素抵抗明显,该部分人群胰岛素抵抗可能与血压升高有关,血压控制达标可改善单纯空腹血糖异常伴原发性高血压患者的胰岛素抵抗和胰岛功能。第二部分:血压下降后,单纯空腹血糖受损合并原发性高血压病的患者的胰岛功能和胰岛素抵抗有显著的改善。本研究中选用的降压药物中,氯沙坦钾在随访12个月时改善胰岛素抵抗及胰岛功能可能优于苯磺酸氨氯地平,但随访24个月、36个月时,两组胰岛素抵抗及胰岛功能均有明显改善,与基线对比差异具有统计学意义,且两组新发糖尿病的发生率无明显差别,提示两种降压药对胰岛素抵抗及胰岛功能的影响差别不明显。
[Abstract]:Background: many studies showed that impaired fasting glucose (IFG) was an independent predictor of diabetes, impaired fasting glucose (IFG) in risk of progression to diabetes was significantly higher than that of the general population, is a huge crowd of candidate for future development into diabetes. At present, has emerged a large number of relevant clinical and impaired fasting glucose basic research and epidemiological studies showed that impaired fasting glucose (IFG) and impaired glucose tolerance (impaired glucose, tolerance, IGT) is only part of the overlap population, and both in insulin resistance (insulin resistance, IR) are obviously different sites, so the exploration of impaired fasting glucose (isolated impaired fasting glucose, i-IFG) has important clinical significance in patients with the onset and prognosis. The evidence showed that 40%~50% patients with essential hypertension have insulin resistance, insulin resistance Abnormal, often bring anti hyperglycemia in recent years, primary hypertension (Essential, Hypertension, EH) are the common pathophysiologic basis with pre diabetes and type 2 diabetes mellitus is the focus of research at home and abroad. Although there are some studies of primary hypertension found that angiotensin receptor antagonists can make 2 to reduce the risk of diabetes, but these studies did not specify that the clinical benefit of different antihypertensive or antihypertensive drugs itself, and impaired fasting glucose (i-IFG) combined with primary high blood pressure (EH) in patients with clinical outcome and intervention research less. So exploring to prevent or reduce fasting impaired fasting glucose (i-IFG) with essential hypertension (EH) method to change the patients of diabetes mellitus, hypertension risk factors of the impaired fasting glucose (i-IFG) affects clinical outcomes Well, observation of antihypertensive drugs itself benefit or make blood sugar level of blood pressure decreased abnormal blood glucose has improved, to effectively prevent or delay the onset of type 2 diabetes, has an important research value and significance. Objective: To observe the relationship between impaired fasting glucose in patients with insulin resistance and islet function and the blood pressure, blood pressure reduction research after the change of impaired fasting glucose and hypertension in patients with islet function and insulin resistance. The research design and methods: This study is divided into two parts: the first part: the experiment selected no previous history of diabetes impaired fasting glucose in patients with 180 cases, blood pressure was measured after divided into primary hypertension group (n=94 cases), normal blood pressure group (n=86 cases), two groups were given the guidance of a healthy lifestyle, essential hypertension group patients were given clinical treatment of antihypertensive (angiotensin Zhang Su receptor blocker or calcium channel blockers), the therapeutic effect of fasting blood glucose of two groups of patients before and after 6 months (FPG), fasting insulin (fins), OGTT 2H (2hPG) blood glucose test, OGTT test 2H insulin (2hins), glycosylated hemoglobin (glycosylatedhemoglobin, HbA1c), and insulin resistance index (HOMA-IR, thehomeostasismodelofinsulinresistance) were selected. The second part: the primary 244 patients with abnormal fasting glucose and hypertension, randomly (124:120) were treated with 50mg/d~ 100mg/d or Losartan Potassium Tablets 2.5mg/d~5.0mg/d Levamlodipine Besylate Tablets aggressiveantihypertensive treatment for 3 years, and also given lifestyle intervention, the blood pressure (bloodpressure, BP (standard) bp130/80mmhg) cases, compared the fasting blood glucose (FPG), fasting insulin (fins), OGTT 2H (2hPG) blood glucose test, OGTT test after 2 H insulin (2hins), glycosylated hemoglobin (HbA1c) and insulin sensitivity index (insulinsensitivityindex, ISI) were observed. Results: the first part: the experimental results compared with the normal blood pressure group, baseline hypertension patients with fasting insulin, 2 hour postprandial insulin and insulin resistance index HOMA-IR increased obviously in two. Group with significant difference (p0.5), outpatient follow-up at 6 months, the hypertension group fins, 2hins, HOMA-IR were significantly lower (P0.05), including 66 cases of primary hypertension patients with decreased blood pressure standard (bp130/80mmhg), 20 cases of primary hypertension patients with decreased blood pressure is not standard, essential hypertension standard sub groups of fins, 2hins, HOMA-IR were lower than the primary hypertension subgroup was not standard (P0.05); normal blood pressure group were fins, 2hins and HOMA-IR compared with baseline did not change significantly between the two groups (P0.05), new onset diabetes The disease incidence rate had no significant difference. The second part of the experiment results: the blood pressure of 2 groups were significantly decreased compared with before treatment (P0.05), after 12 months of treatment with losartan potassium group fins, 2hins decreased, ISI significantly improved than before treatment (P0.05), and levamlodipinebesylate group compared with statistically significant difference (P0.05), for 24 months, 36 months after the two groups of fins, 2hins were significantly decreased, ISI also improved significantly, with significant difference compared with the index before treatment (P0.05), no difference between the groups (P0.05), new onset diabetes between the two groups no significant difference. Conclusion: the first part: simple impaired fasting glucose with insulin resistance in patients with primary hypertension significantly, the population of insulin resistance may be associated with elevated blood pressure, blood pressure control can improve pancreatic island fasting glucose abnormality with essential hypertension in patients with insulin resistance and islet function. The second part: A drop in blood pressure, impaired fasting glucose and hypertension in patients with islet function and insulin resistance were significantly improved. In this study the selection of antihypertensive drugs, losartan at 12 months follow-up, improve insulin resistance and islet function may be better than that of benzene sulfonic acid amlodipine, but after 24 months of follow-up, 36 months, two groups of islet function and insulin resistance were significantly improved, the difference was statistically significant compared with baseline, and the two groups the incidence of new onset diabetes had no significant difference, the results suggest that the effect of two kinds of antihypertensive drugs on insulin resistance and insulin function did not differ significantly.

【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1

【参考文献】