Sun Ningling, Wang Hongyi, Sun Yuemin, Chen Xiaoping, Wang Hao, Zhao Lianyou, Wang Jinping, Zhu Zhiming
Heart Center, Peking University People's Hospital, Beijing, China.
Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China.
Hypertens Res. 2014 Jan;37(1):82-7. doi: 10.1038/hr.2013.126. Epub 2013 Oct 17.
To analyze the clinical significance of the oral glucose tolerance test (OGTT) in the assessment of abnormal glucose metabolism in Chinese patients with hypertension. In this cross-sectional study of 10,173 hypertensive adult patients from eight sites in China, data on patient, clinical and disease characteristics were collected, and fasting plasma glucose (FPG) levels were measured. A subset of 5322 patients also underwent an OGTT. Abnormal glucose metabolism (impaired glucose regulation (IGR) or diabetes mellitus (DM)) was detected in 31.1% of the 10,173 patients by FPG testing and in 67% of the 5322 patients by OGTT. OGTT increased the detection rate by 35.8%. Patients with FPG levels ≥5.6 and ≥6.1 mmol l(-1) had the mean OGTT 2-h plasma glucose levels of 8.79 and 9.68 mmol l(-1), respectively. Compared with normoglycemic patients, those with IGR or DM had higher rates of total proteinuria (normoglycemic 15.8% vs. IGR 22.1% vs. DM 33.7%, P<0.001), a lower absolute estimated glomerular filtration rate (eGFR; in ml min(-1) per 1.73 m(2)) (82.9 vs. 80.77 vs. 79.74, P=0.06) and a higher prevalence of cardiovascular disease (normoglycemic 17.6% vs. IGR/DM 13.8%, P<0.001). Abnormal abdominal circumference, eGFR ≤60 ml min(-1) per 1.73 m(2), and proteinuria were independently associated with abnormal glucose metabolism (IGR or DM). Hypertensive patients who are diabetic or at risk of diabetes are at greater risk of renal damage and cardiovascular disease than those who are normoglycemic. It is insufficient to assess the glucose metabolism status of Chinese hypertensive patients using only FPG testing; the use of OGTT can increase the detection rate by 35.8%. Patients whose FPG levels were <5.6 mmol l(-1) may be found to have abnormal glucose metabolism after an OGTT.
分析口服葡萄糖耐量试验（OGTT）在中国高血压患者糖代谢异常评估中的临床意义。在这项对来自中国8个地点的10173例高血压成年患者的横断面研究中，收集了患者、临床和疾病特征数据，并测量了空腹血糖（FPG）水平。5322例患者的一个子集还进行了OGTT。通过FPG检测，10173例患者中有31.1%检测出糖代谢异常（糖调节受损（IGR）或糖尿病（DM））；通过OGTT检测，5322例患者中有67%检测出糖代谢异常。OGTT使检测率提高了35.8%。FPG水平≥5.6和≥6.1 mmol·l⁻¹的患者，OGTT 2小时血浆葡萄糖水平平均分别为8.79和9.68 mmol·l⁻¹。与血糖正常的患者相比，IGR或DM患者的总蛋白尿发生率更高（血糖正常者为15.8%，IGR者为22.1%，DM者为33.7%，P<0.001），绝对估算肾小球滤过率（eGFR；单位为ml·min⁻¹/1.73 m²）更低（82.9对80.77对79.74，P = 0.06），心血管疾病患病率更高（血糖正常者为17.6%，IGR/DM者为13.8%，P<0.001）。腹围异常、eGFR≤60 ml·min⁻¹/1.73 m²和蛋白尿与糖代谢异常（IGR或DM）独立相关。糖尿病或有糖尿病风险的高血压患者比血糖正常的患者有更大的肾损害和心血管疾病风险。仅使用FPG检测评估中国高血压患者的糖代谢状态是不够的；使用OGTT可使检测率提高35.8%。FPG水平<5.6 mmol·l⁻¹的患者在进行OGTT后可能被发现存在糖代谢异常。
