高血压病患者OGTT1小时切点血糖在筛查糖代谢异常中的意义

摘要

目的探讨高血压病患者葡萄糖耐量试验（OGTT）1小时切点血糖（1hPG）筛查糖代谢异常的可能切点数值和意义。方法纳入2009年1月至2011年6月本院内分泌门诊就诊的高血压病患者112例，行75 g OGTT试验，采用受试者工作特征曲线（ROC曲线）确定糖代谢异常时OGTT 1hPG对应的最佳切点数值，以此切点的数值分两组人群比较两组间的体质量指数（BMI），空腹血糖（FPG），三酰甘油（TG），胆固醇（CHO），高、低密度脂蛋白胆固醇（HDL‐C、LDH‐C），血尿酸（UA），胰岛素抵抗指数（HOMA‐IR）、胰岛β细胞功能（HOMA‐β）水平。结果①研究中新诊断DM为36例（32．1％），糖调节受损（IGR）46例（41．1％），糖耐量正常（NGT）30例（26．8％）。②ROC曲线显示以OGTT 1hPG≥10．1 mmol／L作为诊断糖代谢异常的切点，敏感性89％，特异性90％。③以10．1为切点分组后，1hPG≥10．1 mmol／L组的UA、FPG、HOMA‐IR指数高于＜10．1 mmol／L组（ P ＜0．05），HOMA‐β指数低于＜10．1组（ P ＜0．05），两组BMI、空腹真胰岛素（FTI）、TG、CHO、LDL‐C、HDL‐C、比较差异无统计学意义。结论高血压病患者中，当OGTT 1hPG≥10．1 mmol／L ，已出现明显的糖代谢紊乱，1hPG可反应胰岛素抵抗程度及胰岛β细胞分泌功能。%[Objective]To explore the clinical significance of lh‐plasma glucose (1hPG) cutoff value during oral glucose tolerance test (OGTT) in the screening of abnormal glucose metabolism on hypertension patients .[Methods]A total of 112 hypertension patients were recruited for OGTT .The cutoff value of 1hPG during OGTT was analyzed by receiver operating characteristic (ROC) curve .The tangent point value was used to di‐vide them into two groups .And their values of height ,weight ,body mass index (BMI) ,fasting plasma glu‐cose (FPG) ,triglycerides (TG) ,cholesterol (CHO) ,high & low density lipoprotein cholesterol (HDL‐c &LDH‐c) ,blood uric acid (UA) ,HOMA‐IR and HOMA‐β were measured and compared .[Results](1) A‐mong them ,30 cases (26 .8% ) had normal glucose tolerance (NGT) while 46 cases (41 .1% ) impaired glucose regulation (IGR) .There were 36 new cases (32 .1% ) of diabetes ;(2) According to the results of ROC ,for diagnosing abnormal glucose metabolism ,the optimal cutoff value of 1hPG during OGTT was 10 .1 mmol/L with a sensitivity of 89% and a specificity of 90% ;(3) .In group of 1hPG ≥10 .1 mmol/L ,UA ,FPG and HOMA‐IR index were all higher than those in group of <10 .1 mmol/L ( P <0 .05) while HOMA‐β index was lower than group of <10 .1 mmol/L ( P <0 .05) .No statistic difference existed between two groups in BMI ,FTI ,TG ,CHO ,LDL‐c or HDL‐c .[Conclusion]Hypertension patients with 1hPG ≥10 .1 mmol/L are more likely to have abnormal glucose metabolism .And lh PG may reflect insulin resistance and islet β‐cell function .