陈旧性心肌梗塞者胰岛素水平及临床意义探讨

The change of fasting plasma insulin levels in the aged patients with old myocardial infarction

本研究观测了５０例老年陈旧性心肌梗塞（ＯＭＩ）病人空腹血浆胰岛素（ＩＳ）水平变化，并探讨其临床意义。结果表明，老年０ＭＩ病人空腹血浆ＩＳ、总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）、载脂蛋白Ｂ（ＡｐｏＢ）及脂蛋白（Ａ）水平明显高于正常老年人，高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）水平明显降低。ＯＭＩ病人中空腹ＩＳ水平与ＴＧ、ＡｐｏＢ水平呈显著的正相关性，与ＨＤＬ－ｃ呈显著的负相关性。高血压病组的空腹ＩＳ水平明显高于血压正常组。由此提示，０ＭＩ病人空腹血浆ＩＳ水平的明显增高可能反映体内存在胰岛素抵抗，直接影响脂质代谢，并与高血压病相关，因此在老年冠心病发病中起重要作用。

The fasting plasma insulin level was measured in 50 aged patients with old myocardial infarction (OMI) and its clinical significance was investigated. The results demonstrated that the fasting. plasma levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo B) and lipoprotein (a) [LP(a)] were significantly higher and high density lipoprotein cholesterol (HDL-C) was significantly lower in the aged patients with OMI than in normal aged people. The fasting insulin level was positively correlated with levels of TG and ApoB, and negatively with that of HDL-C in OMI patients. Furthermore, the fasting plasma insulin level was significantly higher in patients with hypertension and OMI than in normal controls. It was suggested that the apparent increase in fasting plasma insulin level in OMI patients might indicate the presence of insulin resistance, which affected lipid metabolism and was associated with hypertension in the aged patients with OMI. Insulin resistance probably plays an important role in the pathogenesis of coronary heart disease in the aged people.