胰岛素抵抗对冠心病不稳定型心绞痛患者支架术后再狭窄的影响

Influence of insulin resistance on restenosis in patients with coronary heart disease and unstable angina after stenting

目的 通过观察冠心病不稳定型心绞痛患者行冠状动脉内支架术前胰岛素抵抗与术后6～8个月内再狭窄的发生情况，进一步明确胰岛素抵抗对冠心病患者支架术后再狭窄的影响。方法 连续观察98例行经皮冠状动脉成形术（PTCA）＋支架术的患者。于经皮冠状动脉介入治疗（PCI）术前清晨空腹测定血糖浓度、胰岛素浓度，并计算胰岛素敏感指数（ISI）。PCI术后6～8个月或有心肌缺血复发证据时复查冠状动脉造影（CAG）。根据再狭窄情况分为再狭窄组和无再狭窄组，对比观察胰岛素抵抗与PCI术后再狭窄之间的关系。结果 胰岛素抵抗组和非胰岛素抵抗组患者空腹血糖无明显差别（P〉0．05），空腹胰岛素（FSI）比较差异有显著性（P〈0．05）；胰岛素抵抗组的病变血管最小直径（MLD）小于胰岛素敏感组[（2．2±0．2）mm比（2．4±0．3）mm]，但2组间差异无显著性（P〉0．05）；多元回归分析发现胰岛素敏感指数（RR=2．763，CI=1．897～4．229，P〈0．01）和支架长度（RR=1．295CI=1．112～1．867，P〈0．05）是PCI术后再狭窄的独立预测因素（P〉0．05）。结论 冠心病不稳定型心绞痛患者胰岛素抵抗与冠状动脉内支架术后再狭窄的发生关系密切。

Objective To investigate the effect of insulin resistance on restenosis in the patients with cornnary heart disease and unstable angina after stenting after 6-8 months tenting. Methods 98 patients received percutaneous transluminal coronary angioplasty （PTCA） and stenting. A fasting blood sample from each patient was obtained in the morning before percutaneous coronary intervention （PCt） and blood glucose concentration and fasting serum insulin （FSI） were tested and insulin sensitivity index （ISI） were calculated. The rechecks of coronary angiography were conducted in the patients with myocardial ischemia or 6-8 months after PCL According to restenosis degrees, the patients were divided into restenosis group and non restenosis group for the comparison of the relationship between restenosis and insulin resistance after PCL Results The fasting plasma glucose was not significantly different in the between insulin resistance group and without insulin resistance group （ P 〉 0.05 ） while the fasting plasma insulin was significantly different between groups （ P 〈 0. 05 ）. The minimal diameter（MLD） of vessels in the group of insulin resistance was smaller than those with insulin sensitivity[ （ 2.2 ＋ 0.2 ） mm vs （2.4 ＋ 0.3 ） mm], but there was no significance （P 〉 0.05）. The multiple regression analysis showed that the insulin sensitivity index （ RR = 2. 763, CI = 1. 897-4.229, P 〈 0.01 ） and the length of stenting （ RR = 1. 295, CI = 1.112-1. 867,P 〈 0.05 ） were independent predicting factors for restenosis after PCI （P 〉 0.05）. Conclusion Insulin resistance is significantly correlated with restenosis after stenting in patients with coronary heart disease and unstable angina pectoris.