维、汉民族冠心病住院患者胰岛素敏感性与多种危险因素分析

Insulin sensitivity and cardiovascular risk factors in Uygur and Han inpatients with coronary heart diseases

摘要:

目的 探讨维、汉民族冠心病患者胰岛素敏感性的异质性和多种危险因素的分布特点。方法 选取2001年至2002年新疆维吾尔自治区人民医院住院的冠心病患者164例（维吾尔族50例，汉族114例）和对照组71例（维族35例，汉族36例），进行葡萄糖糖耐量试验和胰岛素释放试验，运用稳态模式法评价胰岛素敏感性（HOMA IS）。结果 （1）维、汉民族冠心病患者胰岛素敏感性较对照组明显减低[维族（204.02±180.43） vs （409.14±181.06），汉族（258.09±105.66） vs （479.09±200.97），P＜0.05]；冠心病组代谢综合征患病率明显增多[维族（54.0% vs 25.7%），汉族（66.7% vs 22.7%），P＜0.05]。糖尿病患病率明显高于对照组[维族（52.0% vs 0.0%），汉族（64.0% vs 0.0%），P＜0.01]。冠心病组1h胰岛素水平下降和2h血糖水平升高（P＜0.05）。其余各项虽有变化，但差异无统计学意义。代谢综合征患病率和胰岛素敏感性变化无论在对照组或冠心病组内维、汉民族间差异均无统计学意义。（2）维、汉民族冠心病患者存在体质量[（78.06±12.69） vs （72.32±12.03）kg]和体质量指数[BMI（27.29±3.53） vs （25.61±3.42）kg/m2]的显著差异（P＜0.01）。对照组中维、汉两个民族各种危险因素差异无统计学意义（P＞0.05）。（3）多个危险因素对冠心病危险性比较（logistic回归分析）看出，饮酒、糖尿病、高血压与冠心病正相关（P＜0.05）。高密度脂蛋白胆固醇与冠心病呈负相关（P＜0.05）。结论 住院患者中维、汉民族冠心病存在较低的胰岛素敏感性和较高的代谢综合征、糖尿病患病率；维族冠心病患者肥胖显著。该地区饮酒、糖尿病、高血压是维、汉民族冠心病的危险因素。

Abstract:

Objective To explore the heterogeneity of insulin sensitivity (IS) and the distribution of cardiovascular risk factors in the races of the Uygur and Han patients with coronary heart diseases (CHD) in Urumqi. Methods A total of 164 CHD patients (50 Uygurs and 114 Hans) hospitalized in the Autonomous Regional Hospital from 2001 to 2002 were recruited in this study. Another 71 healthy individuals (35 Uygurs and 36 Hans) served as normal controls. Oral glucose tolerance test (OGTT) and insulin release test were used to measure the concentrations of blood glucose and insulin before and after oral 75 g glucose in 0, 0.5, 1, 2 and 3h. The Homeostasis Model Assessment of Insulin Sensitivity (HOMA IS) was calculated by the HOMA model. Results The IS was significantly lower in the CHD patients than in the normal controls [the Uygurs: (204.02±180.43) vs (409.14±181.06); the Hans: (258.09±105.66) vs (479.09±200.97); P＜0.05]. The CHD patients also had higher morbidities of metabolic syndrome (the Uygurs: 54% vs 25.7%; the Hans: 66.7% vs 22.7%; P＜0.05) and of diabetes mellitus (the Uygurs: 52.0% vs 0.0%; the Hans: 64.0% vs 0.0%, P＜0.01) when compared with the normal controls. The CHD patients had significantly decreased 1h insulin and increased 2h glucose than the normal controls (P＜0.05). No significant difference was found in other indices between the CHD patients and normal controls. There was no difference in the morbidity of metabolic syndrome and IS between the 2 ethnics no matter for CHD patients or the normal controls. Significant differences were seen in the body mass [(78.06±12.69) vs (72.32±12.03)kg, P＜0.01] and body mass index [BMI(27.29±3.53) vs (25.61±3.42)kg/m2, P＜0.01] in the two ethnic patients with CHD. But no such difference was seen in the normal controls. Logistic regression analysis showed that alcohol drinking (OR=2.532), diabetes mellitus (OR=2.466), and hypertension (OR=2.355) had positive correlation with CHD (P＜0.05), and high-density lipoprotein cholesterol had negative correlation with CHD (P＜0.05). Conclusion Both Uygur and Han CHD patients in Urumqi have lower IS and higher morbidity of metabolic syndrome and diabetes mellitus. The Uygur CHD patients have higher prevalence of obesity. Alcohol drinking, diabetes mellitus, and hypertension are risk factors of CHD in the two ethnics in the Xinjiang Uygur Autonomous Region.