【摘要】：目的調(diào)查青年大學(xué)生胰島素抵抗的相關(guān)危險(xiǎn)因素及探討其與血壓的關(guān)系。方法納入389名青年大學(xué)生(男性332名,女性57名),根據(jù)按照穩(wěn)態(tài)模型胰島素抵抗指數(shù)(HOMA-IR)的計(jì)算公式(空腹血糖/空腹胰島素*22.5),按照HOMA-IR三分位數(shù)法分為低度IR組(≤2.44)、中度IR組(2.44-3.04)、高度IR組(≥3.04),人數(shù)分別為130,129和130人。分別測(cè)量身高、體重收縮壓(SBP)、舒張壓(DBP),計(jì)算體重指數(shù)(BMI)、平均動(dòng)脈壓(MAP),抽取清晨空腹外周血測(cè)定血清甘油三酯、膽固醇、高密度脂蛋白、低密度脂蛋白、血糖、胰島素、NO、NOs、同型半胱氨酸水平。應(yīng)用SPSS19.0進(jìn)行統(tǒng)計(jì)學(xué)處理,分析胰島素抵抗指數(shù)與各指標(biāo)相關(guān)性,并分析胰島素與相關(guān)危險(xiǎn)因素對(duì)血壓的影響。c2檢驗(yàn)分析組間性別差異,單因素方差分析及Bonferroni分析各組各個(gè)臨床指標(biāo)(計(jì)量資料),pearson分析各指標(biāo)相關(guān)性,多元逐步回歸模型分析胰島素抵抗指數(shù)及相關(guān)因素與外周血壓的關(guān)系。P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1.一般資料比較:(1)性別:IR組間性別分布有統(tǒng)計(jì)學(xué)差異,高度IR組及中度IR組的男性比例均高于低度IR組(87.6%VS 76.9%,P0.05;91.5%VS 76.9%,P0.05),但是高度IR組的男性比例與中度IR組沒(méi)有統(tǒng)計(jì)學(xué)差異(P0.05);(2)體重、體重指數(shù)(BMI)與胰島素抵抗的關(guān)系:隨著胰島素抵抗程度的升高,體重、BMI也升高,體重分別為63.78±10.22kg、71.01±12.28 kg、77.15±12.58kg(P均0.001),相關(guān)系數(shù)r為0.432;BMI分別為21.33±2.74kg/m2、23.54±3.34 kg/m2、25.37±3.25 kg/m2,相關(guān)系數(shù)r為0.470;(3)年齡、身高:組間沒(méi)有統(tǒng)計(jì)學(xué)差異(P均0.05)。2.血脂與胰島素抵抗的關(guān)系:(1)甘油三酯組間存在差異,分別為1.16±0.73mmol/l、1.3±0.65 mmol/l、1.58±0.93 mmol/l,中度-IR和高度-IR均大于低度-IR組(P0.05),但中度-IR組和低度-IR組間沒(méi)有差異(P0.05),與胰島素抵抗相關(guān)系數(shù)r為:0.243(P0.05);(2)HDL組間存在差異,低度-IR組大于高度-IR組,分別為58.48±32.68 mg/dl、46.94±28.81 mg/dl,與胰島素抵抗相關(guān)系數(shù)r為:-0.151(P0.05);(3)低密度脂蛋白、總膽固醇均值之間沒(méi)有統(tǒng)計(jì)學(xué)差異(P0.05)。3.血糖、胰島素與胰島素抵抗的關(guān)系:隨著胰島素抵抗程度的升高,血糖、胰島素也升高,血糖在各組分別為4.32±0.41mmol/l、4.64±0.37mmol/l、5.04±0.56mmol/l(P0.01),相關(guān)系數(shù)r為0.628;胰島素分別為10.5±1.49m U/l、13.36±1.15 m U/l、16.16±1.85 m U/l,與胰島素抵抗呈正相關(guān),相關(guān)系數(shù)r為0.897。4.NO、NOs與胰島素抵抗的關(guān)系:(1)NO的均值有統(tǒng)計(jì)學(xué)差異,分別為88.04±17.61 umol/l、87.48±18.62 umol/l、76.15±23.89 umol/l,高度IR組低于低度IR組和中度IR組(P0.01),低度IR組和中度IR組無(wú)差異(P0.05),與胰島素抵抗相關(guān)系數(shù)r為-10.246;(2)NOS的均值有統(tǒng)計(jì)學(xué)差異,分別為9.58±1.33 umol/l、9.11±1.65 umol/l、8.87±2.53 umol/l,經(jīng)過(guò)兩兩比較得到,低度IR組高于中度IR組和高度IR組(P0.05),中度IR組和高度IR組沒(méi)有統(tǒng)計(jì)學(xué)差異(P0.05),與胰島素抵抗相關(guān)系數(shù)r為-0.141。5.同型半胱氨酸與胰島素抵抗的關(guān)系:同型半胱氨酸分別為5.25±1.13umol/l、5.31±1.26 umol/l、7.14±1.87 umol/l,各組有統(tǒng)計(jì)學(xué)差異,經(jīng)過(guò)兩兩比較得到,低度IR組、中度IR組均低于高度IR組(P0.01),中度IR組和低度IR組無(wú)差異(P0.05),與胰島素抵抗相關(guān)系數(shù)r為0.138(P0.05)。6.胰島素抵抗與血壓的關(guān)系:隨著胰島素抵抗指數(shù)的升高,外周收縮壓、舒張壓、平均動(dòng)脈壓逐漸升高,在低度IR組,收縮壓、舒張壓、平均動(dòng)脈壓分別為118.35±12.76mm Hg、75.72±9.35mm Hg、86.51±10.15mm Hg,高度IR組分別為130.62±14.31 mm Hg、83.19±9.19 mm Hg、95.38±10.38 mm Hg,差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01),胰島素抵抗與血壓存在正相關(guān),相關(guān)系數(shù)r分別為0.275、0.327、0.348,差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。7.胰島素抵抗與相關(guān)危險(xiǎn)因素的關(guān)系:胰島素抵抗的因素為血糖、HCY、體重、LDL(呈正相關(guān)),P0.05;NO(呈負(fù)相關(guān)),P0.05。8.多元逐步回歸分析顯示:(1)外周收縮壓主要與體重、膽固醇、血糖、同型半胱氨酸相關(guān)(P0.05);(2)外周舒張壓主要與體重、膽固醇、血糖、胰島素抵抗指數(shù)(P0.05);(3)外周平均動(dòng)脈壓主要與體重、膽固醇、血糖、同型半胱氨酸相關(guān)(P0.05)。調(diào)整了年齡、性別、體重、BMI、LDL、NO、血糖等因素后,舒張壓隨胰島素抵抗指數(shù)水平增高而上升的趨勢(shì)仍然存在(β=0.136,P=0.049)。結(jié)論1.青年大學(xué)生胰島素抵抗指數(shù)存在性別差異,隨胰島素抵抗程度的增加,男性比例明顯升高;胰島素抵抗與體重、體重指數(shù)正相關(guān);2.青年大學(xué)生胰島素抵抗指數(shù)與甘油三酯、LDL、血糖、胰島素、同型半胱氨酸存在正相關(guān)性,與高密度脂蛋白、NO、NOs負(fù)相關(guān),但青年大學(xué)生胰島素抵抗與膽固醇無(wú)明顯相關(guān);3.青年大學(xué)生胰島素抵抗是舒張壓升高的獨(dú)立危險(xiǎn)因素。早期監(jiān)測(cè)血脂、血糖、胰島素水平有助于及早發(fā)現(xiàn)胰島素抵抗,通過(guò)改變生活方式能夠降低患心血管和代謝相關(guān)疾病的風(fēng)險(xiǎn)。
[Abstract]:Objective to investigate the risk factors of insulin resistance in young college students and to explore the relationship between insulin resistance and blood pressure. Methods 389 young college students (332 male and 57 women) were divided into low degrees according to the formula (fasting glucose / empty abdominal insulin *22.5) according to the steady state model of insulin resistance index (HOMA-IR), and according to the HOMA-IR three quantile method. Group IR (< 2.44), moderate IR group (2.44-3.04), high IR group (> 3.04), the number of people were 130129 and 130 respectively. The height, weight systolic pressure (SBP), diastolic pressure (DBP), body mass index (BMI), mean arterial pressure (MAP) were calculated, and the serum triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, and blood glucose were measured in the early morning fasting peripheral blood. Insulin, NO, NOs, homocysteine levels. Use SPSS19.0 to conduct statistical treatment, analyze the correlation between insulin resistance index and each index, and analyze the gender differences between insulin and related risk factors on blood pressure in.C2 test analysis group, single factor ANOVA and Bonferroni analysis of each group of clinical indicators (measurement data), PE Arson analysis of the correlation of each index, multivariate stepwise regression model analysis of the relationship between insulin resistance index and related factors and peripheral blood pressure,.P0.05 was statistically significant. Results 1. general data were compared: (1) sex: gender distribution in IR groups was statistically significant, and the proportion of men in high IR and moderate IR groups was higher than that in low IR group (87.6%VS 76.9%, P0.05, 91.5%VS 76.9%, P0.05), but the male proportion of the high IR group was not statistically different from that in the moderate IR group (P0.05); (2) the relationship between body weight, body mass index (BMI) and insulin resistance: with the increase of insulin resistance, the weight, BMI also increased, and the weight was 63.78 + 10.22kg, 71.01 + 12.28 kg, 77.15 + 12.58kg (P 0.001). Coefficient r was 0.432; BMI was 21.33 + 2.74kg/m2,23.54 + 3.34 kg/m2,25.37 + 3.25 kg/m2, correlation coefficient r was 0.470; (3) age, height: there was no statistical difference between groups (P 0.05).2. lipid and insulin resistance: (1) there were differences between triglyceride groups, 1.16 + 0.73mmol/l, 1.3 + 0.65 mmol/l, 1.58 + 0.93 mmol/l, moderate -IR And the height -IR was greater than the low -IR group (P0.05), but there was no difference between the moderate -IR group and the low -IR group (P0.05), and the coefficient r of the insulin resistance was 0.243 (P0.05); (2) there were differences between the HDL groups, and the low -IR group was 58.48 + 32.68 mg/dl, 46.94 + 28.81, respectively. There was no statistically significant difference (P0.05).3. blood sugar and insulin resistance between low density lipoprotein and total cholesterol. With the increase of insulin resistance, blood glucose and insulin also increased. The blood sugar in each group was 4.32 + 0.41mmol/l, 4.64 + 0.37mmol/ L, 5.04 + 0.56mmol/l (P0.01), and the correlation coefficient R was 0.628. It was 10.5 + 1.49M U/l, 13.36 + 1.15 m U/l, 16.16 + 1.85 m U/l, which was positively correlated with insulin resistance. The correlation coefficient r was 0.897.4.NO, the relationship between NOs and insulin resistance: (1) the mean value of NO was statistically different, 88.04 + 17.61 umol/l, 87.48 + 18.62 umol/l, 76.15 + 23.89. There was no difference between the low IR group and the moderate IR group (P0.05), and the correlation coefficient of insulin resistance R was -10.246, and (2) the mean value of NOS was statistically different, which were 9.58 + 1.33 umol/l, 9.11 + 1.65 umol/l, 8.87 + 2.53 umol/l, and the low degree IR group was higher than the moderate IR group and the high IR group. P0.05, the correlation coefficient r with insulin resistance was the relationship between -0.141.5. homocysteine and insulin resistance: homocysteine was 5.25 + 1.13umol/l, 5.31 + 1.26 umol/l and 7.14 + 1.87 umol/l respectively. There were statistical differences in each group. After 22 comparison, low degree IR group and moderate IR group were lower than the high IR group (P0.01), moderate IR group and lower group. There was no difference in IR group (P0.05). The correlation coefficient of insulin resistance R was 0.138 (P0.05).6. insulin resistance and blood pressure: with the increase of insulin resistance index, peripheral systolic pressure, diastolic pressure and mean arterial pressure increased gradually, in low IR group, systolic pressure and diastolic pressure, and the mean arterial pressure was 118.35 + 12.76mm Hg, 75.72 + 9.35mm Hg, 86.51, respectively. 10.15mm Hg, the high IR group was 130.62 + 14.31 mm Hg, 83.19 + 9.19 mm Hg, 95.38 + 10.38 mm Hg, the difference had significant statistical significance (P0.01), the insulin resistance was positively correlated with the blood pressure, the correlation coefficient r was 0.275,0.327,0.348, the difference was statistically significant: islet islet The factors of vegetal resistance were blood glucose, HCY, weight, LDL (positive correlation), P0.05; NO (negative correlation), and P0.05.8. multivariate stepwise regression analysis showed that (1) peripheral systolic blood pressure was mainly associated with weight, cholesterol, blood glucose, homocysteine (P0.05); (2) the peripheral diastolic pressure was mainly with weight, cholesterol, blood glucose, and insulin resistance index (P0.05); (3) the peripheral mean Arterial pressure was mainly related to body weight, cholesterol, blood sugar, homocysteine (P0.05). After adjusting the age, sex, weight, BMI, LDL, NO, blood glucose and other factors, the trend of diastolic pressure increased with the increase of insulin resistance index (beta =0.136, P=0.049). Conclusion there is a gender difference in the insulin resistance index of 1. young college students, with the pancreas. The proportion of Isle resistance increased significantly; insulin resistance was positively correlated with body weight and body mass index; 2. the insulin resistance index of young college students was positively correlated with triglyceride, LDL, blood glucose, insulin, homocysteine, and high density lipoprotein, NO, NOs, but there was no insulin resistance and cholesterol in young college students. 3. young college students insulin resistance is an independent risk factor for diastolic blood pressure. Early monitoring of blood lipids, blood sugar, and insulin levels can help to detect early insulin resistance and reduce the risk of cardiovascular and metabolic related diseases by changing the lifestyle.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R587.1

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