胰岛素抵抗对冠状动脉病变的影响

Effects of insulin resistance on coronary arterial lesion in coronary heart disease

目的探讨冠心病不同程度冠状动脉病变时胰岛素敏感性指数的变化及其临床意义。方法116例冠心病患者,根据主要冠状动脉内径狭窄程度、冠状动脉病变累及血管数量以及斑块病变类型不同等分型方法,分别分为轻中度狭窄组和重度狭窄组、单支病变组和多支病变组、稳定性心绞痛组和不稳定性心绞痛或急性心肌梗死组以及Ⅰ、Ⅱ和Ⅲ型斑块组。另取同期冠状动脉造影正常非冠心病者32例为对照组。测定空腹血糖(PGf)和胰岛素(PIf)、餐后2h血糖(PG2h)和餐后2h胰岛素(PI2h)的变化;评价胰岛素敏感性采用胰岛素敏感性指数(ISI)。结果空腹胰岛素、餐后2h胰岛素,在重度狭窄、多支病变、病变不稳定性组及斑块病变Ⅱ、Ⅲ型患者中均显著高于相应的轻中度、单支病变、病变稳定性、Ⅰ型斑块组患者(P<0.05);在重度狭窄、多支病变、病变不稳定组及斑块病变Ⅱ、Ⅲ型患者中存在胰岛素敏感性降低(P<0.05);而轻中度组、单支病变组、病变稳定性组和对照组相比,无明显差异(P>0.05)。结论高胰岛素血症、胰岛素抵抗影响冠心病患者的冠状动脉病变范围、程度和稳定性,在冠心病的发生、发展中有十分重要作用。

Objective To investigate the changes and clinical significance of insulin sensitivity index（ISI） and serum lipid in patients with coronary heart disease（CHD） of coronary lesion with various degrees. Methods Totally 116 CHD patients respectively were divided into mild lesion group and severe lesion group, single-vessel stenosis group and multi-vessels stenoses group, stable angina group and unstable angina or acute myocardial infarction group, plaque type of Ⅰ,Ⅱ,Ⅲ group according to the degrees of coronary maximal stenoses,the number of coronary artery with stenosis and angiographic morophology of plaques. Meanwhile, 32 healthy people with normal coronary arteriongraphy were selected as the control group. The fasting plasma glucose and insulin, fasting and postprandial 2-hour plasma glucose and insulin, ISI and serum lipid were determined, and the changes were observed. The status of insulin resistance（IR） was assessed by the ISI. Results The fasting plasma glucose and insulin, fasting and postprandial 2- hour plasma glucose and insulin and serum lipid in severe lesion group, multi-vessels stenoses group, unstable angina or acute myocardial infarction group and plaque type of Ⅱ,Ⅲ group were significantly higher than those in mild lesion group,single-vessel stenosis group,stable angina group and plaque type of Ⅰ group（P 〈 0.05）. Patients in severe lesion group, multi-vessels stenosese group, unstable angina or acute myocardial infarction group and plaque type of Ⅱ,Ⅲ group had an increase in fasting insulin,a decrease in insulin sensitivity. There was no significant difference in fasting insulin level and insulin sensitivity between normal controls and mild lesion group, single-vessel stenosis group, stable angina group and plaque type of Ⅰ group （ P 〉 0.05 ）. Conclusion Hyperinsulinmia, IR and serious dyslipidaemia affects the scope,severity and stablity of the coronary artery lesions, and might play an important role in the development of coronary atherosclerosls.