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目的探讨运动性高血压(exercise hypertension,EH)与2型糖尿病(type 2 diabetes mellitus,T2DM)及胰岛素抵抗的关系。方法选取2010年8月至2013年7月在遵义市第一人民医院内分泌科门诊和内分泌科住院部初诊的2型糖尿病(T2DM)患者109例作为病例组,匹配年龄、性别后以同期43例健康体检志愿者作为对照组。以Bruce运动方案做次级量症状限制性运动试验,比较分析T2DM患者和对照组运动性高血压的发生率;采用HOMA-IR法评估胰岛素抵抗。应用独立样本t检验和多因素Logistic回归分析,探讨T2DM患者运动性高血压与胰岛素抵抗、糖化血红蛋白、年龄、血脂等的关系。结果病例组运动试验前后收缩压变化幅度显著高于对照组,而且运动性高血压的发生率也明显高于对照组,差异均具有统计学意义(P<0.05)。t检验结果显示,EH组HOMA-IR指数显著高于非EH组,差异具有统计学意义(P=0.013);多因素Logistic回归分析,结果显示HOMA-IR指数进入方程,提示胰岛素抵抗可能是运动性高血压EH发生的危险因素,OR及相应95%置信区间为1.48(1.03~2.12)。结论 T2DM可增加运动性高血压的发生风险;与无运动性高血压的T2DM患者相比,运动性高血压患者可能具有较高的胰岛素抵抗。
Objective To investigate the relationship between exercise-induced hypertension (EH) and type 2 diabetes mellitus (T2DM) and insulin resistance. Methods From August 2010 to July 2013, 109 cases of type 2 diabetes mellitus (T2DM) newly diagnosed in Department of Endocrinology and Endocrinology, First People’s Hospital of Zunyi were enrolled as case group, matched with age and sex, 43 cases Healthy volunteers as a control group. Bruce exercise program to do sub-level symptoms of restricted exercise test, comparative analysis of T2DM patients and control group, the incidence of exercise-induced hypertension; assessment of insulin resistance by HOMA-IR method. Independent sample t-test and multivariate logistic regression analysis were used to explore the relationship between exercise-induced hypertension and insulin resistance, glycosylated hemoglobin, age, blood lipids, etc. in T2DM patients. Results The change of systolic blood pressure before and after exercise test in case group was significantly higher than that in control group, and the incidence of exercise-induced hypertension was also significantly higher than that in control group (P <0.05). t test showed that the HOMA-IR index of EH group was significantly higher than that of non-EH group (P = 0.013). Multivariate Logistic regression analysis showed that HOMA-IR index entered the equation, suggesting that insulin resistance may be a sign of exercise The risk factors for the development of hypertensive EH were OR and corresponding 95% confidence intervals of 1.48 (1.03-2.12). Conclusions T2DM can increase the risk of exercise-induced hypertension. Compared with T2DM without exercise-induced hypertension, patients with exercise-induced hypertension may have higher insulin resistance.