老年急性冠状动脉综合征患者血清肿瘤坏死因子与高胰岛素血症及胰岛素抵抗的关系

Relationship between tumornecrosis factor-α and insulin resistance in elderly patients with acute coronary syndrome

目的探讨老年急性冠状动脉综合征(ACS)患者血清肿瘤坏死因子-α(TNF-α)与高胰岛素血症(HIS)及胰岛素抵抗(IR)的关系。方法采用氧化酶法、放免法和酶联免疫法分别测定50例老年急性冠脉综合征患者(ACS组)和42例正常健康人(对照组)的空腹血糖(FBG)、空腹胰岛素(FINS)及血清TNF-α值,并计算胰岛素敏感性指数(ISI)。结果ACS组FINS、TNF-α水平较对照组显著增高,而ISI较对照组显著降低。相关分析表明,老年ACS患者TNF-α与FINS呈显著正相关,而与ISI呈显著负相关。结论血清TNF-α和FINS水平升高及胰岛素敏感性减低普遍存在于ACS患者中,而且TNF-α水平升高与HIS及胰岛素抵抗程度相关,提示TNF-α与HIS及胰岛素抵抗在冠心病的发病机制中可能具有一定的内在联系。

Objective To investigate the ralationship between hyperinsulinemia（HIS） ,insulin resistance（IR） and tumorneerosis factor-α（TNF-α） in elderly patients with acute coronary syndrome（ACS）. Methods Fasting blood-glucose（FBG）, fasting blood-insulin（FINS） and serum TNF-α were measured in 50 ACS patients（ACS group） and 42 health objects（control group） by oxidase method, RIA and ELISA, respectively. Insulin sensitivity index（ISI） was also calculated. Results Analysis of variance revealed that FINS,TNF-α were significantly higher while ISI lower in ACS group than those in control group. Correlation analysis showed that TNF-α was negatively correlated to ISI ,and positively associated TNF-α and FINS in ACS group. Conclusions Elevated circulating TNF-α and FINS level and declined isulin-sensitivity extensively exist in ACS patients. There is a closely correlation between TNF-α level and FINS and insulin resistance. There might be certain intrinsic associations between TNF-α level and hyperinsulincmia,insulin resistance in the pathophysiology of CHD.