早发冠心病患者子代胰岛素抵抗和心血管病危险因素聚集性研究

Insulin resistance and clustering of cardiovascular risk factors in offsprings of patients with premature coronary heart disease

目的探讨早发冠心病患者子代胰岛素抵抗和心血管危险因素聚集性特点及其相关性。方法入选66例早发冠心病患者的子代76例(病例组),收集其临床资料、血糖、血脂和胰岛素测定结果、心血管危险因素,计算空腹胰岛素抵抗指数(Hom a IR),并与70例非冠心病患者的子代81例(对照组)进行对比研究。结果两组平均年龄、性别比例、患高血压及吸烟的比例、空腹血糖、胆固醇浓度差异无统计学意义(P>0.05)。病例组空腹甘油三酯和胰岛素水平、血脂异常比例、体重指数以及Hom a IR均高于对照组[分别为(1.39±0.43)mmol/L比(1.22±0.36)mmol/L,P<0.01;(10.7±2.6)mU/L比(9.6±2.4)mU/L,P<0.05;31.6%vs 9.9%,P<0.01;(23.09±1.85)比(22.49±1.70),P<0.05;(2.5±0.7)比(2.2±0.6),P<0.01],高密度脂蛋白胆固醇低于对照组[(1.20±0.22)mmol/L比(1.32±0.23)mmol/L,P<0.01]。相关分析显示Hom a IR与体重指数、胰岛素、血糖和甘油三酯成正相关(分别r=0.174,P=0.029;r=0.877,P=0.000;r=0.368,P=0.000;r=0.157,P=0.049)。结论早发冠心病患者子代存在胰岛素抵抗,并且与心血管危险因素聚集性相关联。

Objective To explore the characteristics of insulin resistance and clustering of cardiovascular risk factors in the offsprings of patients with premature coronary heart disease （CHD） and their relationship. Methods Seventy-six offsprings of 66 patients with documented premature CHD were recruited to participate in this study （ Group A）. Their clinical data were collected, levels of fasting blood glucose, lipid and insulin were measured and insulin resistance index （Homa-IR） was estimated with HOMA equation. Eighty-one offsprings of 70 parents without CHD （ Group B） were enrolled as controls. Results No significant difference in age, sex ratio, prevalence of hypertension, prevalence of smoking, fasting blood levels of glucose and cholesterol between Group A and Group B （P〉0.05） was found. Levels of fasting serum triglyceride （TG） and insulin, prevalence of abnormal blood lipid, body mass index （BMI） and Homa-IR were significantly higher in Group A than those in Group B [（1.39±0. 43 ） mmol/L vs （1.22±0.36） mmol/L,P〈0.01; （10.7±2.6） mU/L vs （9.6±2.4） mU/L,P〈0. 05; （31.6% vs 9.9%）, P〈0.01 ; （23.09±1.85 vs 22.49±1.70）, P〈0.05; （2.5±0.7 vs 2.2±0.6）, P〈0.01 ; respectively ]. Level of high-density lipoprotein cholesterol was significantly lower in Group A than that in Group B [（1.20±0. 22） mmol/L vs （1.32±0.23） mmol/L,P〈0.01]. Levels of fasting serum cholesterol and glucose, mean age, prevalence of hypertension and smoking were comparable between the two groups. Homa-IR positively correlated with BMI, blood insulin glucose and TG （r=0.174,P=0.029 ;r=0.877 ,r=0.000; r=0. 368,P=0.000;r =0.157 ,P=0.049,respectively）. Conclusions Insulin resistance appeared in the offsprings of patients with premature CHD, which correlated to the clustering of other cardiovascular risk factors.