Nghiên cứu đặc điểm lâm sàng, tổn thương cơ quan đích và tình trạng kháng insulin ở bệnh nhân tăng huyết áp nguyên phát có rối loạn glucose máu lúc đói tt tiếng anh

MINISTRY OF EDUCATION & TRAINING MINISTRY OF NATIONAL DEFENSE 108 INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES NGUYEN THI HONG VAN RESEARCHING CLINICAL FEATURES, SOME TARGET ORGAN LESIONS AND TARGET INSULIN RESISTANCE IN NEW HYPERTENSIVE PATIENTS WITH IMPAIRED FASTING GLUCOSE Major : Cardiology Code : 62720141 SUMMARY OF DOCTORAL DISSERTATION HA NOI - 2019 THE THESIS WAS DONE AT 108 INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES Full name of supervisor: Dr VIEN VAN DOAN Associate Prof Dr NGUYEN VAN QUYNH Reviewer 1: Associate Prof Dr Nguyen Oanh Oanh Reviewer 2: Associate Prof Dr Vu Bich Nga Reviewer 3: Associate Prof Dr Vu Dien Bien This thesis will be presented at Institute Council at 108 Institute of Clinical Medical and Pharmaceutical Sciences At Day Month Year The thesis can be found at: National Library of Vietnam Library of 108 Institute of Clinical Medical and Pharmaceutical Sciences BACKGROUND Impaired fasting glucose is a new concept developed by the American Diabetes Association in 1997 and approved by the World Health Organization in 1998 to address "pre-diabetes" as a risk factor of type diabetes mellitus In 2003, the American Diabetes Association proposed lowering the threshold to 5.6 mmol/l and impaired fasting glucose was defined when fasting glucose levels ranged from 5.6 to 6.9 mmol/l for early detection of potential risks of type diabetes mellitus The rate of prediabetes is increasing rapidly, especially in people with high cardiovascular risk factors Although in the pre-diabetic stage, blood glucose levels increase slightly, it begins to cause damage to the target organs, especially when combined with other cardiovascular risk factors such as obesity, hypertension, etc., then the lesions appear early and more The glucose tolerance test has not been routinely used in cases of impaired fasting glucose, therefore, many cases of diabetes are missed On the other hand, screening for target lesions in high-risk individuals for aggressive intervention for the purpose of delaying or minimizing complications is not concerned Therefore, this topic is researched for two goals: Study clinical characteristics, target organ lesions, glucose tolerance test results and insulin resistance in patients with new hypertension associated with impaired fasting glucose Evaluate the relationship between insulin resistance and target organ lesions in patients with new hypertension associated with impaired fasting glucose CHAPTER 1: OVERVIEW 1.1 CONCEPTS OF INSULIN AND INSULIN RESISTANCE 1.1.1 The concept of insulin Insulin is a hormone secreted by the pancreas β cells to maintain blood glucose levels Insulin regulates carbohydrate metabolism, lipid and protein metabolism, promotes cell division and growth 1.1.2 The concept of insulin resistance "Insulin resistance is a decrease in the biological response of cells, organs, and organizations to the actions of insulin." The concept of insulin resistance refers to the decline in the biological response of insulin on the target cells, which is usually expressed by an increase in insulin levels in the blood 1.1.3 Methods to determine insulin resistance  Endogenous methods - Basic fasting insulin measurement: (I0) - Oral glucose tolerance test: quantifies concentration of glucose and fasting plasma insulin (G0, I0), after 75 g of glucose intake for 5-10 minutes After 120 minutes, blood is taken again to measure the concentration of glucose and insulin (G120, I120)  Exogenous methods - The glucose “clamp”: This method is considered to be the most accurate or "gold standard" Glucose level is "clamped" or fixed at a certain level while evaluating the secretion of insulin If the patient needs a large amount of glucose to maintain normal blood glucose levels, then it is not insulin resistant  Some indicators of insulin resistance - Index HOMA-IR (Homeostasis Model Assessment Insulin Resistance): HOMA- IR = - QUICKI index: Quantitative Insulin Sensitivity Check Index QUICKI = / log (I + G ) - ß cell function Homeostasis Model Assessment based on Matthew D + HOMA -% ß = 1.1.4 The pathology and clinical syndrome associated with insulin resistance 1.4.1.1 The role of insulin resistance in type diabetes Insulin resistance is a prerequisite in glucose metabolism disorder Forms of insulin resistance are also abundant including: decreased ability to inhibit glucose production in the liver, reduced ability of glucose uptake in peripheral tissues and reduced ability to use glucose in organs The early phase of insulin secretion is reduced in both impaired fasting glucose and glucose tolerance disorders In the late phase of insulin secretion, people with impaired fasting glucose are normal while glucose tolerance disorder are reduced  Impaired fasting glucose In 2003, the American Diabetes Association proposed lowering the threshold to 5.6 mmol/l (100/mg/dl) and impaired fasting glucose is determined when fasting plasma glucose level from 5.6 to 6.9 mmol/l This standard is widely applied today  Glucose tolerance disorder Glucose tolerance disorder is a concept adopted by the World Health Organization in 1980 for use in pre-diabetes and the regulation of oral glucose tolerance testing for diagnosing and quantifying fasting plasma glucose level, followed by 75 g of glucose dissolved in 250 - 300 ml of drinking water within - 15 minutes After 120 minutes, blood is taken again to quantify glucose level to evaluate results - Glucose level after hour glucose tolerance testing is 140/90 mmHg and with impaired fasting glucose according to standards of American Diabetes Association 2003 when the fasting plasma glucose level was 5, mmol/L - 6.9 mmol/L * Exclusion criteria Patients with a history of hypertension, diabetes or hypoglycemic agents, acute pathological conditions: Myocardial infarction, unstable angina, acute stroke, etc., Patients who were or are under treatment for chronic diseases such as renal failure, severe liver failure, etc patients taking certain drugs that affect test results such as glucocorticoid group, thiazide diuretics, lipid lowering drugs 2.1.2 Group of pathological symptoms * Criteria for selecting patients The study population consisted of 119 people with primary hypertension first discovered with BP> 140/90 mmHg and with fasting plasma glucose of < 5.6mol/L Exclusion criteria are the same as the exclusion criteria in the preceding group 2.1.3 Control group: The control group included 55 people of the same age who were healthy, without hypertension, with fasting plasma glucose 0,05 60-69 95 47,8 106 48,6 p>0,05 ≥70 54 27,1 49 22,5 p>0,05 The average age 63,9 ± 8,2 63,5 ± 7,9 p>0,05 Comment: The mean age of respondents was 63 years Age group 60-69 was the highest in both groups, (p> 0,05) Table 3.4 Anthropometric characteristics between the two research groups Group of Group of pathological diseases symptoms Parameter p (n = 218) (n = 199) n % n % Average BMI 22,68 ± 2,25 23,07 ± 2,23 p>0,05 BMI 0,05 BMI: 18.5 - 22.9 108 54,3% 111 50,9% p>0,05 BMI: 23 - 24.9 63 31,7% 68 31,2% p>0,05 BMI: 25-29.9 21 10,6% 35 16,1% p>0,05 BMI ≥ 30 1% 0,5% p>0,05 Average WHR 0.89 ± 0.05 0.91 ± 0.04 p 0.05 Average ACR 13,74 ± 15,13 22,99 ± 21,81 p 0,05 1,014 5,250 p0,05 83,3 0,475 75,6 0,143 1,574 p>0,05 14 History of drinking Yes 13 21,0 49 79,0 1,552 0,392 No 36 23,1 120 76,9 6,144 Little exercise Yes 24 22,2 84 77,8 0,714 0,344-1,481 No, little 25 22,7 85 77,3 exercise Glucose concentrations after glucose tolerance test G 120 0,05 p 0,05) * Characteristics of anthropometry: BMI and WHR Obesity is now considered to be central to the metabolic syndrome closely related to insulin resistance The rate of obesity is 16.1 % in group of disease and 10.6% in group of pathological symptoms (p> 0.05) The WHR (waist circumference) in group of disease is 83%, statistically significant higher than that in group of pathological symptoms (69.8%), the difference is statistically significant (p