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目的通过检测老年高血压病患者血清游离脂肪酸(FFA)水平,探讨FFA在老年高血压合并胰岛素抵抗(IR)中的意义。方法回顾性分析老年高血压病患者228例,按照胰岛素抵抗指数(HOMA-IR),将高血压患者分为合并胰岛素抵抗组(IR组)156例和无胰岛素抵抗组(非IR组)72例;并选择同期住院的非高血压患者125例作为对照组。测量患者身高、体重、腰围(WC)、臀围(HC),检测空腹血糖(FBG)、空腹胰岛素(FINS)、血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)和FFA,并计算体重指数(BMI)、腰臀比(WHR)和HOMA-IR。结果高血压病组与对照组比较,年龄、性别构成、BMI、血脂水平均无明显差异(P>0.05);但收缩压(SBP)、舒张压(DBP)、WHR、FBG、FINS、FFA和HOMA-IR在高血压病组中均显著高于对照组(P<0.05或P<0.01)。进一步研究显示,高血压IR组的血清FINS、TG、FFA和HOMA-IR均显著高于非IR组(P<0.05或P<0.01);并且,IR组的冠心病(51.3%)和脑梗死(36.5%)患病率显著高于非IR组(分别为34.8%和18.1%)(均为P<0.05或P<0.01)。相对风险比分别为1.979(95%CI:1.110～3.527)和2.907(95%CI:1.463～5.774)。相关分析显示,高血压病患者中,血清FFA与SBP,WC,WHR,FINS,TG,Ln(HOMA-IR)均呈显著正相关(r值分别为0.334,0.348,0.518,0.355,0.345,0.411)(均为P<0.05或P<0.01)。多元回归分析显示,WHR和TG是影响血清FFA的独立危险因素。结论 IR与老年高血压病及心脑血管并发症密切相关;血清FFA浓度升高是导致老年高血压和IR的重要原因之一,它可以作为高血压病合并IR的生化标志。检测FFA对于老年高血压病合并IR的早期发现并及时干预具有重要意义。
Objective To explore the significance of FFA in elderly patients with hypertension and insulin resistance (IR) by measuring serum free fatty acid (FFA) levels in elderly patients with essential hypertension. Methods A total of 228 elderly hypertensive patients were retrospectively analyzed. According to the insulin resistance index (HOMA-IR), 156 hypertensive patients with insulin resistance (IR group) and 72 insulin-resistant (non-IR) ; And select the same period hospitalized non-hypertensive patients 125 cases as a control group. Body height, weight, WC, HC, FBG, FINS, TC, TG, LDL cholesterol LDL-C, HDL-C and FFA, and calculated body mass index (BMI), waist-to-hip ratio (WHR) and HOMA-IR. Results There were no significant differences in age, gender, BMI and lipid profile between hypertensive group and control group (P> 0.05). However, systolic blood pressure (SBP), diastolic blood pressure (DBP), WHR, FBG, FINS, HOMA-IR was significantly higher in hypertensive patients than in controls (P <0.05 or P <0.01). Further studies showed that the levels of FINS, TG, FFA and HOMA-IR in hypertension group were significantly higher than those in non-IR group (P <0.05 or P <0.01), and IR group had coronary heart disease (51.3%) and cerebral infarction (36.5%) were significantly higher than those in non-IR patients (34.8% and 18.1% respectively) (P <0.05 or P <0.01, respectively). The relative risk ratios were 1.979 (95% CI: 1.110-3.527) and 2.907 (95% CI: 1.463-5.704, respectively). Correlation analysis showed that there was a significant positive correlation between serum FFA and SBP, WC, WHR, FINS, TG and Ln (HOMA-IR) in patients with hypertension (r = 0.334,0.348,0.518,0.355,0.345,0.411 ) (All P <0.05 or P <0.01). Multivariate regression analysis showed that WHR and TG were independent risk factors affecting serum FFA. Conclusion IR is closely related to hypertension and cardiovascular and cerebrovascular complications in elderly patients. Elevated serum FFA concentration is one of the most important causes of hypertension and IR in elderly patients. It may be used as a biochemical marker of hypertension complicated by hypertension. Detection of FFA for senile hypertension with early detection of IR and timely intervention of great significance.