| Objective:Type 2 diabetes mellitus(T2DM)is a chronic metabolic disease characterized by hyperglycemia caused by a variety of causes,mainly due to reduced insulin secretion and / or insulin resistance in terminal organs.Since the survey in 2008,the number of diabetic patients in China has ranked first in the world.Among patients with diabetes,type 2 diabetes accounts for more than 90%,and according to the International Diabetes Federation,the number of adults with diabetes worldwide will increase to 552 million by 2030.Hypertension is considered to be one of the most important risk factors for the complications of type 2 diabetes,and the two are often accompanied by each other.Studies show that of 25,817 patients with type 2 diabetes,59.8% have hypertension.When the two coexist,the risk of cardiovascular disease can reach 4-8 times that of the normal population.The specific mechanism of type 2 diabetes with hypertension is very complicated.In 1998,Reaven first proposed the concept of insulin resistance(IR),which is not only an independent risk factor for the development of type 2 diabetes,but also seriously affects the occurrence and development of cardiovascular and cerebrovascular diseases,hypertension,and metabolic syndrome.In recent years,some scholars have proposed that the interaction between insulin resistance and the renin-angiotensin-aldosterone system(RAAS)system may be involved in the development of type 2 diabetes with hypertension.In this study,the RAAS activity in circulating blood of patients with type 2 diabetes and hypertension was measured,and fasting blood glucose and fasting insulin were used to calculate a steady-state model to evaluate the insulin resistance index(HOMA2-IR),insulin sensitivity index(HOMA2-% S),and islets ?-cell function index(HOMA2-% B)is used to evaluate the correlation between RAAS level and insulin resistance,to explore the interaction mechanism between insulin resistance and RAAS,and to provide a new method for clinically reducing the incidence of type 2 diabetes with hypertension Treatment target.Methods:A total of 206 patients who were hospitalized and diagnosed in the department of endocrinology and cardiology of Chengde Central Hospital from November 2018 to January 2020 were selected as subjects.Divided into three groups according to the WHO 1999 diagnostic criteria for type 2 diabetes and the 2005 diagnostic guidelines for hypertension prevention and control in China.There were 62 patients with type 2 diabetes and hypertension(T2DM + EH group,n = 62),64 patients with type 2 diabetes(no hypertension)(T2DM group,n = 64),and 80 patients with simple hypertension(no type 2 diabetes)(EH group,n = 80).After admission,the patient was asked about the medical history in detail,and the patients who met the inclusion exclusion criteria were screened.The general information was recorded:gender(male/female),age,height,weight,systolic blood pressure(SBP),diastolic blood pressure(DBP),diabetes and / or duration of diabetes / duration of hypertension,,and calculate body mass index(BMI)using height and weight.Laboratory examination:All patients collected elbow venous blood in the morning after fasting for 8 hours,and checked fasting blood glucose and total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),Low-density lipoprotein cholesterol(LDL-C),ions(K +,Na +),uric acid(UA),cystatin C(Cys-c),and fasting plasma renin(PRA),angiotensin(Ang? ?)),Aldosterone(ALD).Patients in the T2DM + EH group received their glycated hemoglobin(Hb A1c)and fasting insulin(FINS)values simultaneously.SPSS 22.0 statistical software was used for data analysis and processing.One-way ANOVA was used for comparison between multiple groups of normal distribution data.Kruskal-Wallis test was used when the data did not meet normal distribution.The fasting blood glucose and fasting insulin values were used to calculate the insulin resistance index(HOMA2-IR),insulin sensitivity index(HOMA2-%S),and beta cell function index(HOMA2-%B)of patients in the T2DM + EH group to assess the degree of insulin resistance.Finally,Pearson correlation analysis was used to evaluate the correlation between Ang and ?HOMA2-IR and age,BMI,blood pressure,diabetes,and duration of hypertension in the T2DM + EHgroup.The difference was statistically significant with P <0.05.Results:1.Comparison of basic data and biochemical indicators of three groups of patientsThere were 62 patients in T2DM + EH group(35 males and 27 females),64 patients in T2DM group(37 males and 27 females),and 80 patients in EH group(40 males and 40 females).There was no significant difference in gender,age,blood pressure level,HDL-C,K +,Na +,UA,Cys-c among the three groups(P> 0.05).BMI,FPG,and TC of T2DM + EH group and T2DM group were higher than EH group,the difference was statistically significant(P <0.05).T2DM + EH group had higher TG than EH group,T2DM group had higher LDL-C than EH group,and the differences were statistically significant(P <0.05).2.Comparison of plasma PRA,Ang and ALD levels in three grou? ps of patientsRegarding the RAAS index,Ang ?in T2DM + EH group and T2DM group was higher than that in EH group,and the difference was statistically significant(P <0.05).There was no statistical difference in plasma PRA and ALD levels between the three groups(P> 0.05).3.Correlation analysis between Ang and various factors in patients in ?T2DM + EH groupThe results of Pearson correlation analysis showed that Ang II and age of patients in the T2DM + EH group [r=0.291,P=0.022],fasting blood glucose [r=0.373,P=0.003],fasting insulin [r=0.529,P=0.000],HOMA2-IR [r=0.556,P=0.000] and duration of diabetes [r=0.354,P=0.005] were positively correlated,and negatively correlated with HOMA2-%S [r=-0.518,P=0.000].There was no correlation with HOMA2-%B,blood pressure levels,blood lipids,ions,and the duration of hypertension.4.Correlation analysis between HOMA2-IR and various factors in patients in T2DM + EH groupThe results of Pearson correlation analysis showed that HOMA2-IR and Ang II [r=0.556,P=0.000],fasting blood glucose [r=0.503,P=0.000],and duration of diabetes [r=0.287,P=0.024],duration of hypertension [r=0.344,P=0.006],glycated hemoglobin [r=0.257,P=0.044],fasting insulin [r=0.982,P=0.000] were positively correlated with patient age,BMI,blood pressure levels,PRA,ALD,blood lipids,blood uric acid and other conditions were not related.Conclusion:1.T2DM + EH group and T2DM group BMI,TC are higher than EH group,T2DM + EH group TG is higher than EH group,T2DM group LDL-C is higher than EH group,indicating that patients with type 2 diabetes are more prone to blood lipids disorder.2.By comparing the RAAS indicators,it was found that when type 2 diabetes and hypertension coexist,Ang? significantly increased.3.The results of Pearson correlation analysis showed that Ang ?was not only related to insulin resistance,but also related to the patient's age,duration of diabetes,and fasting blood glucose.The above factors all affected the level of Ang in patients with type 2 ? diabetes and hypertension.4.The degree of insulin resistance in patients with type 2 diabetes and hypertension is affected by Ang?,blood glucose control,type 2 diabetes,and the duration of hypertension,but not with the patient's age,BMI,blood pressure level,PRA,ALD,blood lipids,and uric acid Correlation. |
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