Lu Jun-xi, Bao Yu-qian, Jia Wei-ping, Xiang Kun-san
Department of Endocrinology and Metabolism, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2006 Dec;28(6):756-60.
To study the clinical characteristics of hypertensive subjects with metabolic syndrome and its components in communities.
Totally 5628 subjects aged over 20 years were included. Measurement indicators included height, weight, waist circumference (W) , hip circumference, systolic pressure (SP) , diastolic pressure (DP) , total cholesterol ( TC) , triglyceride (TG) , high-density lipoprotein cholesterol (HDL-C) , low-density lipoprotein cholesterol (LDL-C) , fasting plasma glucose (FPG) , 2 h postprandial plasma glucose (2hPG) , fasting serum insulin (FIN) , and 2 h postprandial serum insulin (2hIN). Body mass index (BMI) , waist to hip ratio (WHR), and homeostatic model approach-insulin resistance index (HOMA-IR) were calculated. According to 1999 WHO definition of metabolic syndrome, these individuals were divided into 4 groups: non-metabolic disorder group, isolated hypertension group, hypertension with one component of metabolic syndrome group, hypertension with two components of metabolic syndrome group, and hypertension with three components of metabolic syndrome group.
Among subjects with hypertension, 15. 37% were patients with isolated hypertension, 32. 40% with one component of metabolic syndrome, 33. 36% with two components of metabolic syndrome, and 18. 87% with three components of metabolic syndrome. BMI, W, WHR, TC, TG, LDL-C, FPG, 2hPG, FIN, 2hIN and HOMA-IR in three groups (hypertension with one component of metabolic syndrome group, hypertension with two components of metabolic syndrome group, and hypertension with three components of metabolic syndrome group) significantly increased than those in isolated hypertension group (P < 0. 01 ). The hypertensive patients showed a higher insulin resistance, despite other metabolic disorders. Furthermore, the hypertensive patients with more components of metabolic syndrome showed a higher chance to get insulin resistance. Multiple stepwise regression analysis showed FPG, 2hPG, FIN, 2hIN, BMI, SP and TC were risk factors of HOMA-IR.
Patients with isolated hypertension are rare in community-based population. About 85% of hypertensive patients have more than one metabolic disorders, more than half of were metabolic syndrome. The percentage of total body fat, levels of plasma glucose, serum insulin, total cholesterol and systolic blood pressure are independent risk factors of insulin resistance.
研究社区高血压合并代谢综合征及其组分的临床特点。
纳入5628名20岁以上受试者。测量指标包括身高、体重、腰围(W)、臀围、收缩压(SP)、舒张压(DP)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、餐后2小时血糖(2hPG)、空腹血清胰岛素(FIN)和餐后2小时血清胰岛素(2hIN)。计算体重指数(BMI)、腰臀比(WHR)和稳态模型评估胰岛素抵抗指数(HOMA-IR)。根据1999年世界卫生组织代谢综合征的定义,将这些个体分为4组:非代谢紊乱组、单纯高血压组、高血压合并一种代谢综合征组分组、高血压合并两种代谢综合征组分组和高血压合并三种代谢综合征组分组。
高血压患者中,单纯高血压患者占15.37%,合并一种代谢综合征组分的患者占32.40%,合并两种代谢综合征组分的患者占33.36%,合并三种代谢综合征组分的患者占18.87%。三组(高血压合并一种代谢综合征组分组、高血压合并两种代谢综合征组分组和高血压合并三种代谢综合征组分组)的BMI、W、WHR、TC、TG、LDL-C、FPG、2hPG、FIN、2hIN和HOMA-IR均显著高于单纯高血压组(P<0.01)。高血压患者存在较高的胰岛素抵抗,尽管存在其他代谢紊乱。此外,合并代谢综合征组分越多的高血压患者发生胰岛素抵抗的几率越高。多元逐步回归分析显示FPG、2hPG、FIN、2hIN、BMI、SP和TC是HOMA-IR的危险因素。
社区人群中单纯高血压患者少见。约85%的高血压患者合并一种以上代谢紊乱,其中半数以上为代谢综合征。体脂总量百分比、血糖水平、血清胰岛素水平、总胆固醇水平和收缩压是胰岛素抵抗的独立危险因素。