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目的探讨胰岛素抵抗与老年男性高血压和卒中的关系。方法采用前瞻性设计,收集70例脑梗死(脑梗死组)、62例脑出血(脑出血组)、58例非卒中(对照组)老年男性患者的临床资料。每组再根据有无高血压病史进一步分层,3组依次有高血压病史分别为40、42、32例,无高血压病史分别为30、20、26例。清晨空腹取血,分别测定血脂、空腹血糖、空腹胰岛素,计算胰岛素敏感指数。在控制高血压、脂质异常后,应用多元Logistic回归分析卒中与胰岛素抵抗的关系。结果①与对照组比较,脑梗死组和脑出血组三酰甘油、胆固醇、低密度脂蛋白胆固醇、空腹胰岛素水平升高,差异有统计学意义(P<0.05);高密度脂蛋白胆固醇、胰岛素敏感指数水平降低,差异有统计学意义(P<0.05)。②按有无高血压病史进行分层后比较胰岛素抵抗,3组中无论有无高血压病史,脑梗死和脑出血患者的空腹胰岛素及胰岛素敏感指数与对照组比较,差异均有统计学意义(均P<0.05)。高血压合并卒中患者的空腹胰岛素、胰岛素敏感指数与血压正常卒中患者比较,差异有统计学意义(P<0.05)。而3组空腹血糖比较,差异无统计学意义(P>0.05)。③控制了高血压、脂质异常等因素之后,多元Logistic回归分析显示,胰岛素抵抗是卒中的独立危险因素(P=0.010,OR=1.495,95%CI:1.102～2.028)。结论高血压可能通过增加胰岛素抵抗而增加卒中发生的风险。胰岛素抵抗可能是老年男性卒中发生的独立危险因素。
Objective To investigate the relationship between insulin resistance and hypertension in elderly men and stroke. Methods The prospective design was used to collect clinical data of 70 elderly patients with cerebral infarction (cerebral infarction group), 62 cerebral hemorrhage (cerebral hemorrhage group) and 58 non-stroke (control group) elderly men. Each group was further stratified according to whether there was a history of hypertension or not. There were 40, 42 and 32 cases of hypertension history in the three groups, respectively. There were 30, 20 and 26 cases without history of hypertension respectively. Fasting blood in the morning, were measured lipid, fasting blood glucose, fasting insulin, calculated insulin sensitivity index. After controlling for hypertension and lipid abnormalities, multivariate Logistic regression was used to analyze the relationship between stroke and insulin resistance. Results ① Compared with the control group, the levels of triglyceride, cholesterol, low density lipoprotein cholesterol and fasting insulin in cerebral infarction group and cerebral hemorrhage group were significantly increased (P <0.05); high density lipoprotein cholesterol, insulin Sensitive index decreased, the difference was statistically significant (P <0.05). (2) insulin resistance was compared after stratified according to the history of hypertension, the fasting insulin and insulin sensitivity index in patients with cerebral infarction and cerebral hemorrhage were compared with those in control group All P <0.05). The fasting insulin and insulin sensitivity index of hypertensive patients with stroke were significantly different from those of patients with normal blood pressure (P <0.05). The fasting blood glucose in the three groups, the difference was not statistically significant (P> 0.05). ③ After controlling for hypertension and lipid abnormalities, multiple logistic regression analysis showed that insulin resistance was an independent risk factor for stroke (P = 0.010, OR = 1.495, 95% CI: 1.102-2.028). Conclusion Hypertension may increase the risk of stroke by increasing insulin resistance. Insulin resistance may be an independent risk factor for stroke in older men.