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2024-5-25
Vol 32, issue 5

ISSUE

2020 年5 期 第28 卷

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炎性因子和胰岛素抵抗指数与脑卒中合并 H 型高血压患者的关系研究

Relationship between inflammatory factors and insulin resistance indexand stroke patients complicated with H-type hypertension

作者:周函,黄文胜,冷利华,赵喜鹏,晏晶晶

单位:
246003 安徽省安庆市,中国人民解放军海军安庆医院;通信作者:黄文胜,E-mail:304496283@qq.com
关键词:
脑卒中;H 型高血压;炎性因子;胰岛素抵抗指数
Keywords:
Stroke;H-type hypertension;Inflammatory factors;Insulin resistance index
CLC:
R 743 R 544.1
DOI:
DOI:10.3969/j.issn.1008-5971.2020.05.003
Funds:
“十三五”国家重点研发计划—精准医学研究专项(2016YFC0903100,2016YFC0903101)

摘要:

背景 近年来我国脑卒中合并 H 型高血压临床发病率不断升高,而有研究表明炎性反应和胰岛素抵抗可影响脑卒中疾病进程。目的 探讨炎性因子和胰岛素抵抗指数(HOMA-IR)与脑卒中合并H型高血压患者的关系。方法 选取 2016 年 1 月—2019 年 11 月中国人民解放军海军安庆医院心内科及神经内科诊治的脑卒中患者 136 例,根据同型半胱氨酸和血压,单纯性脑卒中患者 33 例作为 A 组,单纯性高血压患者 38 例作为 B 组,单纯性高同型半胱氨酸患者 23 例作为 C 组,H 型高血压患者 42 例作为 D 组。比较四组患者一般资料、同型半胱氨酸、空腹血糖(FPG)、空腹胰岛素(FINS)、HOMA-IR 及炎性因子〔包括肿瘤坏死因子 α(TNF-α)、白介素 1β(IL-1β)和超敏 C 反应蛋白(hs-CRP)〕;脑卒中合并 H 型高血压患者炎性因子与 HOMA-IR 相关性分析采用 Pearson 相关分析及多因素线性回归分析。采用受试者工作特征曲线(ROC 曲线)评价炎性因子、HOMA-IR 对脑卒中合并 H 型高血压患者的诊断价值。结果 C 组、D 组患者同型半胱氨酸高于 A 组、B 组(P<0.05),B 组、D 组患者收缩压、舒张压高于 A组、C 组(P<0.05)。B 组、C 组、D 组患者 FPG、FINS 和 HOMA-IR 高于 A 组(P<0.05),D 组患者 FPG、FINS 和HOMA-IR 高于 B 组、C 组(P<0.05)。B 组、C 组、D 组患者 TNF-α、IL-1β、hs-CRP 水平高于 A 组(P<0.05),D 组患者 TNF-α、IL-1β、hs-CRP 水平高于 B 组、C 组(P<0.05)。Pearson 相关分析结果显示,脑卒中合并 H 型高血压患者 TNF-α、hs-CRP 与 HOMA-IR 均呈正相关(r 值分别为 0.329、0.296,P 值分别为 <0.001、0.001);多因素线性回归分析结果显示,TNF-α( β= 0.614)、hs-CRP( β= 0.983)是脑卒中合并 H 型高血压患者 HOMA-IR 的独立影响因素(P<0.05)。ROC 曲线分析显示,TNF-α、IL-1β、hs-CRP 和 HOMA-IR 对脑卒中合并 H 型高血压患者诊断价值的 ROC 曲线下面积分别为 0.700〔95%CI(0.601,0.799)〕、0.967〔95%CI(0.936,0.998)〕、0.983〔95%CI(0.964,1.000)〕和 0.989〔95%CI(0.977,1.000)〕,最佳临界值分别为 18.1 ng/L、15.4 μg/L、11.4 mg/L和 2.49。结论 脑卒中合并 H 型高血压患者 TNF-α、IL-1β、hs-CRP 及 HOMA-IR 较高,其对脑卒中合并 H 型高血压有一定诊断价值,且 TNF-α、hs-CRP 与 HOMA-IR 呈正相关。

Abstract:

Background In recent years,the clinical incidence of stroke complicated with H-type hypertensionin China has been increasing.However,studies have shown that inflammatory response and insulin resistance can affect theprogression of stroke.Objective To explore the relationship between inflammatory factors and insulin resistance index(HOMA-IR)and stroke patients complicated with H-type hypertension.Methods A total of 136 stroke patients diagnosed and treated inthe Department of Cardiology and Neurology,the PLA Navy Anqing Hospital were selected from January 2016 to November 2019.According to homocysteine levels and blood pressure, the patients were divided into group A(simple stroke,n=33),groupB(stroke complicated with hypertension,n=38),group C(stroke complicated with high homocysteine,n=23) and groupD(stroke complicated with H-type hypertension,n=42).The general information,homocysteine,fasting blood glucose (FPG),fasting insulin (FINS),HOMA-IR and inflammatory factors〔including tumor necrosis factor α (TNF-α),interleukin1β (IL-1β) and hypersensitive C reactive protein (hs-CRP)〕were compared among the four groups. Pearson correlationanalysis and multiple linear regression analysis were used to analyze the correlation between inflammatory factors and HOMA-IR in stroke patients complicated with H-type hypertension. The receiver operating characteristic curve (ROC curve) was usedto evaluate the diagnostic value of inflammatory factors and HOMA-IR in stroke patients complicated with H-type hypertension.Results Homocysteine levels in groups C and D were statistically significantly higher than those in groups A and B,systolicpressure and diastolic pressure in groups B and D were statistically significantly higher than those in group A and C(P<0.05).Levels of FPG,FINS,HOMA-IR,TNF-α,IL-1β,hs-CRP in groups B, C and D were statistically significantly higherthan those in group A(P<0.05),and levels of FPG,FINS,HOMA-IR,TNF-α,IL-1βand hs-CRP in group D werestatistically significantly higher than those in groups B and C(P<0.05).Pearson correlation analysis results showed that,TNF-α(r=0.329, P<0.001),hs-CRP(r=0.296, P=0.001)were positively correlated wirh HOMA-IR.Multivariatelinear regression analysis showed that,TNF-α ( β =0.614),hs-CRP( β =0.983) were independent influencing factors ofHOMA-IR in stroke patients complicated with H-type hypertension(P<0.05).ROC curve analysis showed that the area underthe ROC curve (AUC) of the diagnostic value of TNF-α, IL-1β, hs-CRP and HOMA-IR for stroke patients complicatedwith H-type hypertension was 0.700〔95%CI (0.601,0.799)〕,0.967〔95%CI (0.936,0.998)〕,0.983〔95%CI (0.964,1.000)〕and 0.989〔95%CI(0.977,1.000)〕,respectively,and the optimal critical values were 18.1 ng/L, 15.4 μg/L, 11.4 mg/Land 2.49, respectively.Conclusion TNF-α,IL-1β,hs-CRP and HOMA-IR are higher in stroke patients complicatedwith H-type hypertension,which has certain diagnostic value for stroke patients complicated with H-type hypertension,andTNF-α,hs-CRP are positively correlated with HOMA-IR.

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