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目的探讨中老年原发性高血压(EH)患者胰岛β细胞早期分泌功能变化与高血压病程及分级的关系。方法中老年EH患者106例,年龄(58.4±8.5)岁,按照高血压病程随机分为≤1年组(n=35)、1.1～4.9年组(n=34)和≥5年组(n=37);按照高血压分级随机分为:1级高血压(血压140～159/90～99mmHg,n=53)、2级高血压(血压160～179/100～109mmHg,n=30)、3级高血压(收缩压≥180mmHg、舒张压≥110mmHg,n=23)。治疗前行标准口服葡萄糖耐量试验,同时测空腹和餐后30min血糖、胰岛素及C肽水平和血压等。并计算胰岛素抵抗指数(HOMA-IR)、早期胰岛素分泌指数(ΔI30/ΔG30)的变化。结果≥5年组的ΔI30/ΔG30分泌量(2.1±4.5)较≤1年组(10.3±4.2)和1.1～4.9年组(10.9±4.2),分别下降79.6%和80.7%,但在高血压各分级组无明显差异(P>0.05)。随着EH病程延长,胰岛素抵抗也逐渐加重,≥5年组HOMA-IR(11.8±0.8)比≤1年组(5.5±0.6)和1.1～4.9年组(6.5±0.8),分别增加至2.1和1.7倍(均P<0.01)。3级高血压HOMA-IR(10.4±1.6)比1级高血压(4.2±1.0)和2级高血压(6.5±2.0),分别增加至2.5和1.6倍(均P<0.01)。结论中老EH病程与β细胞早期分泌功能损害和胰岛素抵抗相关,EH分级与胰岛素抵抗相关,与ΔI30/ΔG30无关。
Objective To investigate the relationship between the changes of early secretory function of pancreatic β cells and the course and classification of hypertension in middle-aged and elderly patients with essential hypertension (EH). Methods One hundred and sixty elderly patients with EH (mean age 58.4 ± 8.5) were randomly divided into group ≤ 1 year (n = 35), 1.1-4.9 years (n = 34) and ≥ 5 years (N = 53), grade 2 hypertension (n = 30), blood pressure 160 ~ 179/100 ~ 109mmHg, Grade 3 hypertension (systolic BP ≥ 180 mmHg, diastolic BP ≥ 110 mmHg, n = 23). Standard oral glucose tolerance test before treatment, at the same time fasting and postprandial blood glucose 30min, insulin and C-peptide levels and blood pressure. The changes of insulin resistance index (HOMA-IR) and early insulin secretion index (ΔI30 / ΔG30) were calculated. Results Compared with ≤1 year group (10.3 ± 4.2) and 1.1-9.9 year group (10.9 ± 4.2), the ΔI30 / ΔG30 secretion of ≥5 years group decreased by 79.6% and 80.7% respectively No significant difference between the grading group (P> 0.05). With the prolongation of EH, insulin resistance also gradually increased. HOMA-IR (11.8 ± 0.8) in ≥ 5 years group was significantly higher than that in ≤1 year group (5.5 ± 0.6) and in 1.1-9.9 years group (6.5 ± 0.8) And 1.7 times (all P <0.01). Grade 3 HOMA-IR (10.4 ± 1.6) increased to 2.5 and 1.6 times (P <0.01) than Grade 1 hypertension (4.2 ± 1.0) and Grade 2 hypertension (6.5 ± 2.0), respectively. Conclusion The course of middle-aged and old EH is related to the early secretory function damage and insulin resistance of β-cell. The classification of EH is related to insulin resistance, but not to ΔI30 / ΔG30.