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胰岛素抵抗与冠心病严重程度的相关性研究
Study on the relationship between insulin resistance and coronary heart disease

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DOI:
作者:
苏征佳，陈桢玥，陆国平
Su Zhengjia, Chen Zhenyue, Lu Guoping
作者单位:
瑞金医院
Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai
关键词:
胰岛素抵抗，冠状动脉病变，心功能，院内预后
Insulin resistance，Coronary artery disease， In-hospital prognosis， Heart function
摘要:
目的：探讨胰岛素抵抗与冠心病患者冠状动脉病变严重程度及院内预后的关系。方法：共入选了355例冠脉造影检查者，根据冠脉情况分为正常对照组、单支病变组、双支病变组和多支病变组，测定各组空腹血糖及空腹胰岛素水平，计算其稳态模型胰岛素抵抗指数（HOMA-IR）和Gensini积分，分析胰岛素抵抗对冠状动脉严重程度及心功能的影响。结果：冠心病各组中的HOMA-IR和空腹血胰岛素（FINS）水平均显著高于正常对照组（P＜0.05）。HOMA-IR与Gensini积分、甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白（LDL-C）、空腹血糖（FPG）、空腹血胰岛素（FINS）、体重指数（BMI）、左室舒张末内径（LVEDD）、左室收缩末内径（LVESD）均呈显著正相关（P＜0.05），HOMA-IR与射血分数（LVEF）呈显著负相关（P＜0.01）。校正年龄、血压、血糖、血脂等影响后，HOMA-IR仍与Gensini积分呈显著正相关（P＜0.01）。线性回归分析显示，FPG、Gensini积分、LVEDD、TG是影响HOMA-IR的独立因素；FINS、TC、LVEF、LVESD是影响Gensini积分的独立因素。结论：在有胰岛素抵抗的冠心病患者中，其胰岛素抵抗状态与冠脉病变程度密切相关，且在院内发生心衰和死亡的风险增加。
Objective: To explore the relationship between insulin resistance and severity level of coronary heart disease including various coronary lesion degree，in-hospital prognosis. Methods: Totally 355 patients confirmed by coronary angiography were enrolled. They were divided into four groups according to vessels condition：one-vessel disease group，two-vessel disease group，three-vessel disease group and normal control group. Homeostasis model assessment of insulin resistance index (HOMA-IR) and Gensini’s score of coronary stenosis were calculated. We analyzed the relationship among IR、severity of coronary artery stenosis and in-hospital prognosis. Results: HOMA-IR and FINS in CHD groups were significantly higher than those in the control group (P＜0.05). HOMA-IR were positively correlated with Gensini’s score、TG、TC、LDL-C、FPG、FINS、BMI、LVEDD、LVESD (P＜0.05)，but negatively correlated with LVEF (P＜0.01). After adjusting the influential factors such as age、blood pressure、blood glucose、blood lipids，HOMA-IR was still positively correlated with Gensini’s score (P＜0.01). Multivariate linear regression model showed that FPG、Gensini’s score、LVEDD and TG were independent factors for HOMA-IR. Conclusions: Insulin resistance in patients with CHD closely correlated with the severity of coronary artery stenosis and was in-hospital prognosis.

 

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