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糖负荷后胰岛素与空腹胰岛素在心血管危险因素评估中的比较

Comparison of postprandial insulin and fasting insulin on the evaluation of cardiovascular risk factors

摘要:

目的 通过比较糖负荷后胰岛素(2hINS)和空腹胰岛素(FINS)在评估心血管危险因素中的差异,探讨联合应用2hINS和FINS评估胰岛素抵抗的可行性.方法 研究对象为2008年5月经口服葡萄糖耐量试验(OGTT)进行糖尿病筛查的北京某院校员工,检测空腹和糖负荷后2 h血糖(2hPG)、胰岛素.分别以空腹胰岛素或2hINs胰岛素≥95%分位点判定高胰岛素血症(HINS).结果 筛查共1148名,FINS、2hINS在性别间分布无差异.糖代谢异常人群合并糖负荷后高胰岛素血症(2 hHINS)的比例为40.8%,显著高于合并空腹高胰岛素血症(FHINS)的比例(18.4%,P<0.01).2 hHINS人群聚集心血管危险因素的数目较FHINS人群无差异.偏相关分析显示在调整了性别、年龄、体质指数和腰围变量后,2hINS与2hPG的相关强度(r=0.370)高于FINS与空腹血糖(r=0.104);FINS与TG、HDL-C的相关强度高于2hINS,而2hINS与舒张压、总胆固醇、低密度脂蛋白胆固醇的相关强度高于FINS.Logistic回归分析显示FHINS、2hHINS均是发生代谢综合征的独立危险因素,其OR(95%CI)分别为5.11(2.953~8.842)、3.46(2.109~5.687).结论 2hINS和FINS均与心血管病危险因素密切相关,与不同心血管危险因素的相关性有所不同.联合应用FINS和2hINS评估胰岛素抵抗更有益.

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abstracts:

Objective To study the feasibility of using postprandial insulin (2hINS) and fasting insulin (FINS) on evaluation of insulin resistance, comparison was conducted between 2hINS and FINS on evaluation of cardiovascular risk factors. Methods A survey were conducted among individuals in the community in May 2008 and data of routine clinical examination were collected. All subjects were investigated and received 75 g oral glucose tolerance test (OGTT), and fasting and OGTT2 h blood glucose as well as insulin concentrations were determined. Hyperinsulinemia was defined as a FINS or 2bINS concentration at or above the 95th percentile of the distribution among normal glucose tolerance individuals. Results 1148 individuals were investigated and insulin concentration in male was similar to female. Prevalence of 2hHINS (40.8%) in individuals with abnormal glucose metabolism was higher than FHINS ( 18. 4%, P <0. 01 ). The number of metabolic risk factors in subjects with 2hHINS was similar to subjects with FHINS. After adjustment by sex, age, BMI and waist circumference, partial correlation analysis showed that the correlation between 2hINS and 2hPG(r=0.370) was higher than that of FINS and FPG(r =0. 104); FINS was higher correlated with TG and HDL- cholesterol than 2hINS, however, 2hINS was higher correlated with diastolic blood pressure, total cholesterol and LDL-cholesterol than FINS. Logistic regression analysis showed that FHINS and 2hHINS were both the independent risk factor of metabolic syndrome, the OR (95% CI) were 5. 11 (2.953 - 8. 842) and 3.46 (2. 109 - 5.687). Conclusion 2hINS and FINS were both closely associated with cardiovascular risk factors. The correlation was inconsistent when 2bINS and FINS were related to different risk factors. The combination of 2hINS and FINS might be more helpful on evaluation of insulin resistance.

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作者: 方福生 [1] 田慧 [1] 李春霖 [1] 闫双通 [1] 苗新宇 [1] 成晓玲 [1]
期刊: 《中华医学杂志》2011年91卷14期 946-949页 MEDLINEISTICPKUCSCD
分类号: R9
栏目名称: 临床研究
DOI: 10.3760/cma.j.issn.0376-2491.2011.14.003
发布时间: 2011-06-10
基金项目:
全军医药卫生科研基金课题
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