青年大学生胰岛素抵抗相关危险因素及对血压的影响

发布时间：2018-08-08 13:40

【摘要】：目的调查青年大学生胰岛素抵抗的相关危险因素及探讨其与血压的关系。方法纳入389名青年大学生(男性332名,女性57名),根据按照稳态模型胰岛素抵抗指数(HOMA-IR)的计算公式(空腹血糖/空腹胰岛素*22.5),按照HOMA-IR三分位数法分为低度IR组(≤2.44)、中度IR组(2.44-3.04)、高度IR组(≥3.04),人数分别为130,129和130人。分别测量身高、体重收缩压(SBP)、舒张压(DBP),计算体重指数(BMI)、平均动脉压(MAP),抽取清晨空腹外周血测定血清甘油三酯、胆固醇、高密度脂蛋白、低密度脂蛋白、血糖、胰岛素、NO、NOs、同型半胱氨酸水平。应用SPSS19.0进行统计学处理,分析胰岛素抵抗指数与各指标相关性,并分析胰岛素与相关危险因素对血压的影响。c2检验分析组间性别差异,单因素方差分析及Bonferroni分析各组各个临床指标(计量资料),pearson分析各指标相关性,多元逐步回归模型分析胰岛素抵抗指数及相关因素与外周血压的关系。P0.05为差异有统计学意义。结果1.一般资料比较:(1)性别:IR组间性别分布有统计学差异,高度IR组及中度IR组的男性比例均高于低度IR组(87.6%VS 76.9%,P0.05;91.5%VS 76.9%,P0.05),但是高度IR组的男性比例与中度IR组没有统计学差异(P0.05);(2)体重、体重指数(BMI)与胰岛素抵抗的关系:随着胰岛素抵抗程度的升高,体重、BMI也升高,体重分别为63.78±10.22kg、71.01±12.28 kg、77.15±12.58kg(P均0.001),相关系数r为0.432;BMI分别为21.33±2.74kg/m2、23.54±3.34 kg/m2、25.37±3.25 kg/m2,相关系数r为0.470;(3)年龄、身高:组间没有统计学差异(P均0.05)。2.血脂与胰岛素抵抗的关系:(1)甘油三酯组间存在差异,分别为1.16±0.73mmol/l、1.3±0.65 mmol/l、1.58±0.93 mmol/l,中度-IR和高度-IR均大于低度-IR组(P0.05),但中度-IR组和低度-IR组间没有差异(P0.05),与胰岛素抵抗相关系数r为:0.243(P0.05);(2)HDL组间存在差异,低度-IR组大于高度-IR组,分别为58.48±32.68 mg/dl、46.94±28.81 mg/dl,与胰岛素抵抗相关系数r为:-0.151(P0.05);(3)低密度脂蛋白、总胆固醇均值之间没有统计学差异(P0.05)。3.血糖、胰岛素与胰岛素抵抗的关系:随着胰岛素抵抗程度的升高,血糖、胰岛素也升高,血糖在各组分别为4.32±0.41mmol/l、4.64±0.37mmol/l、5.04±0.56mmol/l(P0.01),相关系数r为0.628;胰岛素分别为10.5±1.49m U/l、13.36±1.15 m U/l、16.16±1.85 m U/l,与胰岛素抵抗呈正相关,相关系数r为0.897。4.NO、NOs与胰岛素抵抗的关系:(1)NO的均值有统计学差异,分别为88.04±17.61 umol/l、87.48±18.62 umol/l、76.15±23.89 umol/l,高度IR组低于低度IR组和中度IR组(P0.01),低度IR组和中度IR组无差异(P0.05),与胰岛素抵抗相关系数r为-10.246;(2)NOS的均值有统计学差异,分别为9.58±1.33 umol/l、9.11±1.65 umol/l、8.87±2.53 umol/l,经过两两比较得到,低度IR组高于中度IR组和高度IR组(P0.05),中度IR组和高度IR组没有统计学差异(P0.05),与胰岛素抵抗相关系数r为-0.141。5.同型半胱氨酸与胰岛素抵抗的关系:同型半胱氨酸分别为5.25±1.13umol/l、5.31±1.26 umol/l、7.14±1.87 umol/l,各组有统计学差异,经过两两比较得到,低度IR组、中度IR组均低于高度IR组(P0.01),中度IR组和低度IR组无差异(P0.05),与胰岛素抵抗相关系数r为0.138(P0.05)。6.胰岛素抵抗与血压的关系:随着胰岛素抵抗指数的升高,外周收缩压、舒张压、平均动脉压逐渐升高,在低度IR组,收缩压、舒张压、平均动脉压分别为118.35±12.76mm Hg、75.72±9.35mm Hg、86.51±10.15mm Hg,高度IR组分别为130.62±14.31 mm Hg、83.19±9.19 mm Hg、95.38±10.38 mm Hg,差异有显著统计学意义(P0.01),胰岛素抵抗与血压存在正相关,相关系数r分别为0.275、0.327、0.348,差异具有统计学意义(P0.01)。7.胰岛素抵抗与相关危险因素的关系:胰岛素抵抗的因素为血糖、HCY、体重、LDL(呈正相关),P0.05;NO(呈负相关),P0.05。8.多元逐步回归分析显示:(1)外周收缩压主要与体重、胆固醇、血糖、同型半胱氨酸相关(P0.05);(2)外周舒张压主要与体重、胆固醇、血糖、胰岛素抵抗指数(P0.05);(3)外周平均动脉压主要与体重、胆固醇、血糖、同型半胱氨酸相关(P0.05)。调整了年龄、性别、体重、BMI、LDL、NO、血糖等因素后,舒张压随胰岛素抵抗指数水平增高而上升的趋势仍然存在(β=0.136,P=0.049)。结论1.青年大学生胰岛素抵抗指数存在性别差异,随胰岛素抵抗程度的增加,男性比例明显升高;胰岛素抵抗与体重、体重指数正相关;2.青年大学生胰岛素抵抗指数与甘油三酯、LDL、血糖、胰岛素、同型半胱氨酸存在正相关性,与高密度脂蛋白、NO、NOs负相关,但青年大学生胰岛素抵抗与胆固醇无明显相关;3.青年大学生胰岛素抵抗是舒张压升高的独立危险因素。早期监测血脂、血糖、胰岛素水平有助于及早发现胰岛素抵抗,通过改变生活方式能够降低患心血管和代谢相关疾病的风险。
[Abstract]:Objective to investigate the risk factors of insulin resistance in young college students and to explore the relationship between insulin resistance and blood pressure. Methods 389 young college students (332 male and 57 women) were divided into low degrees according to the formula (fasting glucose / empty abdominal insulin *22.5) according to the steady state model of insulin resistance index (HOMA-IR), and according to the HOMA-IR three quantile method. Group IR (< 2.44), moderate IR group (2.44-3.04), high IR group (> 3.04), the number of people were 130129 and 130 respectively. The height, weight systolic pressure (SBP), diastolic pressure (DBP), body mass index (BMI), mean arterial pressure (MAP) were calculated, and the serum triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, and blood glucose were measured in the early morning fasting peripheral blood. Insulin, NO, NOs, homocysteine levels. Use SPSS19.0 to conduct statistical treatment, analyze the correlation between insulin resistance index and each index, and analyze the gender differences between insulin and related risk factors on blood pressure in.C2 test analysis group, single factor ANOVA and Bonferroni analysis of each group of clinical indicators (measurement data), PE Arson analysis of the correlation of each index, multivariate stepwise regression model analysis of the relationship between insulin resistance index and related factors and peripheral blood pressure,.P0.05 was statistically significant. Results 1. general data were compared: (1) sex: gender distribution in IR groups was statistically significant, and the proportion of men in high IR and moderate IR groups was higher than that in low IR group (87.6%VS 76.9%, P0.05, 91.5%VS 76.9%, P0.05), but the male proportion of the high IR group was not statistically different from that in the moderate IR group (P0.05); (2) the relationship between body weight, body mass index (BMI) and insulin resistance: with the increase of insulin resistance, the weight, BMI also increased, and the weight was 63.78 + 10.22kg, 71.01 + 12.28 kg, 77.15 + 12.58kg (P 0.001). Coefficient r was 0.432; BMI was 21.33 + 2.74kg/m2,23.54 + 3.34 kg/m2,25.37 + 3.25 kg/m2, correlation coefficient r was 0.470; (3) age, height: there was no statistical difference between groups (P 0.05).2. lipid and insulin resistance: (1) there were differences between triglyceride groups, 1.16 + 0.73mmol/l, 1.3 + 0.65 mmol/l, 1.58 + 0.93 mmol/l, moderate -IR And the height -IR was greater than the low -IR group (P0.05), but there was no difference between the moderate -IR group and the low -IR group (P0.05), and the coefficient r of the insulin resistance was 0.243 (P0.05); (2) there were differences between the HDL groups, and the low -IR group was 58.48 + 32.68 mg/dl, 46.94 + 28.81, respectively. There was no statistically significant difference (P0.05).3. blood sugar and insulin resistance between low density lipoprotein and total cholesterol. With the increase of insulin resistance, blood glucose and insulin also increased. The blood sugar in each group was 4.32 + 0.41mmol/l, 4.64 + 0.37mmol/ L, 5.04 + 0.56mmol/l (P0.01), and the correlation coefficient R was 0.628. It was 10.5 + 1.49M U/l, 13.36 + 1.15 m U/l, 16.16 + 1.85 m U/l, which was positively correlated with insulin resistance. The correlation coefficient r was 0.897.4.NO, the relationship between NOs and insulin resistance: (1) the mean value of NO was statistically different, 88.04 + 17.61 umol/l, 87.48 + 18.62 umol/l, 76.15 + 23.89. There was no difference between the low IR group and the moderate IR group (P0.05), and the correlation coefficient of insulin resistance R was -10.246, and (2) the mean value of NOS was statistically different, which were 9.58 + 1.33 umol/l, 9.11 + 1.65 umol/l, 8.87 + 2.53 umol/l, and the low degree IR group was higher than the moderate IR group and the high IR group. P0.05, the correlation coefficient r with insulin resistance was the relationship between -0.141.5. homocysteine and insulin resistance: homocysteine was 5.25 + 1.13umol/l, 5.31 + 1.26 umol/l and 7.14 + 1.87 umol/l respectively. There were statistical differences in each group. After 22 comparison, low degree IR group and moderate IR group were lower than the high IR group (P0.01), moderate IR group and lower group. There was no difference in IR group (P0.05). The correlation coefficient of insulin resistance R was 0.138 (P0.05).6. insulin resistance and blood pressure: with the increase of insulin resistance index, peripheral systolic pressure, diastolic pressure and mean arterial pressure increased gradually, in low IR group, systolic pressure and diastolic pressure, and the mean arterial pressure was 118.35 + 12.76mm Hg, 75.72 + 9.35mm Hg, 86.51, respectively. 10.15mm Hg, the high IR group was 130.62 + 14.31 mm Hg, 83.19 + 9.19 mm Hg, 95.38 + 10.38 mm Hg, the difference had significant statistical significance (P0.01), the insulin resistance was positively correlated with the blood pressure, the correlation coefficient r was 0.275,0.327,0.348, the difference was statistically significant: islet islet The factors of vegetal resistance were blood glucose, HCY, weight, LDL (positive correlation), P0.05; NO (negative correlation), and P0.05.8. multivariate stepwise regression analysis showed that (1) peripheral systolic blood pressure was mainly associated with weight, cholesterol, blood glucose, homocysteine (P0.05); (2) the peripheral diastolic pressure was mainly with weight, cholesterol, blood glucose, and insulin resistance index (P0.05); (3) the peripheral mean Arterial pressure was mainly related to body weight, cholesterol, blood sugar, homocysteine (P0.05). After adjusting the age, sex, weight, BMI, LDL, NO, blood glucose and other factors, the trend of diastolic pressure increased with the increase of insulin resistance index (beta =0.136, P=0.049). Conclusion there is a gender difference in the insulin resistance index of 1. young college students, with the pancreas. The proportion of Isle resistance increased significantly; insulin resistance was positively correlated with body weight and body mass index; 2. the insulin resistance index of young college students was positively correlated with triglyceride, LDL, blood glucose, insulin, homocysteine, and high density lipoprotein, NO, NOs, but there was no insulin resistance and cholesterol in young college students. 3. young college students insulin resistance is an independent risk factor for diastolic blood pressure. Early monitoring of blood lipids, blood sugar, and insulin levels can help to detect early insulin resistance and reduce the risk of cardiovascular and metabolic related diseases by changing the lifestyle.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1

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