【摘要】 目的 :探讨老年高血压病患者的胰岛素抵抗 (insulinresistance,IR)及脂代谢状况 ,指导老年高血压病的合理治疗。方法 :测定 2 10例老年高血压病患者及 30例正常对照组的血清总胆固醇 (TC)、甘油三酯 (TG)、载脂蛋白A1(APO A1)及载脂蛋白B(APO B) ,计算空腹胰岛素 (FLns) /空腹葡萄糖 (FBG)比值和胰岛素曲线下面积 (RI AUC) /葡萄糖曲线下面积 (GAUC)比值作为IR指标 ,并进行相关分析 ,对其中长期服用氯沙坦 (≥ 6个月 )患者的IR指标也进行了对比分析。结果 :与正常对照组比较 ,老年高血压病组的TC、TG、APO B、FLns、RIAUC、FLns/FBG及RIAUC/GAUC明显升高 (P <0 .0 5～ 0 .0 1) ,APO A1明显降低 (P <0 .0 5 ) ,并发冠心病组IR及脂代谢异常更明显 (P <0 .0 5～ 0 .0 1) ,而且FLns/FBG及RIAUC/GAUC分别与平均动脉压、左室肌重量指数、TG及APO B呈正相关 ,与APO A1呈负相关。长期用氯沙坦患者IR指标改变轻于整体高血压病组。结论 :老年高血压病也存在IR和脂代谢紊乱 ,且IR与脂代谢异常及左室肥厚的发生有关 ;氯沙坦对IR无不良影响更多还原

【Abstract】 Objective: Our aim was to study the insulin resistance(IR) and dyslipidemia in old people with hypertension. Methods: Serum total cholesterol(TC),triglycerides(TG),apolipoprotein A1(APO A1),apolipoprotein B(APO B),fasting glucose(FBG),and insulin were determined.The ratio of fasting insulin/fasting glucose(FLns/FBG) and the ratio of area under insulin curve/area under glucose curve (RIAUC/GAUC) after oral glucose tolerance test were calculated in patients with hypertension and healthy controls(≥60 years old). Linear correlation was analyzed between IR indices and MAP,LVWI,lipids, and apolipoproteins.The IR indices of the patients using Losartan more than 6 months were also compared. Results: Compared with the healthy controls,the TC,TG,APO B, FLns,FLns/FBG,RIAUC, and RIAUC/GAUC in patients significantly increased(P<0.05～0.01),The APO A1 significantly decreased(P<0.05) in patients with hypertension.The IR and dyslipidemia were more serious in the patients with coronary heart disease(P<0.05～ 0.01 ).The ratio of FLns/FBG and the ratio of RIAUC/GAUC were positively correlated with MAP,LVWI, TG, and APO B(P<0.05～0.01) ,and negatively correlated with APO A1 (P<0.05) in hypertension.Compared with all the old people with hypertension,the changes of IR indices of the patients using Losartan for a long time were relatively small. Conclusion: The IR and dyslipidemia exist in old people with hypertension, and the IR is closely correlated with dyslipidemia and LVWI.Losrtan does not exaggerated IR.更多还原