北京地区1359名非糖尿病人群心血管病危险因素与胰岛素抵抗的关系研究

摘要

Objective To explore the association between risk factors of cardiovascular diseases (CVD) and insulin resistance in a cross-sectional study.Methods An investigation on risk factors of CVD was carried out using stratified-random sampling method among 1475 participants in Beijing.Homeostasis model assessment index(HOMA) was calculated to assess the insulin resistance in 1359 non-diabetic subjects aged 25-64 years.Insulin resistance was defined as HOMA index (fasting glucose in mmol/L×fasting insulin in mU/L/22.5) in the top quartile of the studied population.Results The degree of correlation between risk factors and natural logarithm of HOMA index in descending order were glucose,body mass index (BMI),triglyceride ( TG ),waist circumstance,high density lipoprotein- cholesterol (HDL-C),uric acid,diastolic blood pressure,systolic blood pressure and total cholesterol(TC) (all P＜0.01 ).After adjusting factors as sex and age,glucose (r=0.49),BMI(r=0.44),TG (r=0.44),waist circumstance (r=0.41),uric acid (r=0.33) and HDL-C (r=-0.32),the systolic blood pressure (r=0.20),diastolic blood pressure (r=0.18) and TC (r=0.16) were independently correlated with HOMA index (P＜0.001).Sex(OR=1.75) ,low HDL-C(OR= 1.80),hyperuricemia(OR=2.11 ),high TG(OR=2.14) and central obesity(OR=2.68)appeared to be independently correlated to insulin resistance in multiple logistic regression analysis.Conclusion The risk factors of CVD as low HDL-C,high TG,central obesity and hyperuricemia were independently correlated to insulin resistance.%目的 采用横断面研究的方法 分析北京地区非糖尿病人群各心血管病危险因素与胰岛素抵抗的关系.方法 采用分层随机抽样方法 在年龄25～64岁的北京市自然人群中选取1475人,利用该人群中未患糖尿病的1359人资料对各心血管疾病危险因素与胰岛素抵抗关联的密切程度进行分析.分析中采用稳态模式评估法(HOMA)获得的HOMA指数作为胰岛素抵抗程度的评价指标.结果 将HOMA指数取自然对数后进行分析,心血管病危险因素与HOMA指数均存在不同程度的关联(P＜0.001).按关联密切程度由高到低依次为血糖、体重指数(BMI)、甘油三酯(TG)、腰围(WC)、高密度脂蛋白胆固醇(HDL-C)、血清尿酸、DBP、SBP和总胆固醇(TC).在调整了性别和年龄后,血糖(r=0.49)、BMI(r=0.44)、TG(r=0.44)、WC(r=0.41)、HDL-C(r=-0.32)、尿酸(r=0.33)、SBP(r=0.20)、DBP(r=0.18)和TC(r=0.16)依然和HOMA指数存在关联(P＜0.001).将HOMA指数位于人群上四分之一分位者定义为有胰岛素抵抗,多因素logistic回归分析显示性别(OR=1.75)、低HDL-C(OR=1.80)、高尿酸血症(OR=2.11)、高TG(OR=2.14)和腹部肥胖(OR=2.68)与胰岛素抵抗独立相关.结论 心血管病危险因素均与胰岛素抵抗存在不同程度的关联,其中低HDL-C、高TG、腹部肥胖和高尿酸血症与胰岛素抵抗独立相关.