胰岛素抵抗对冠心病患者介入治疗前后血浆内皮素与血管性血友病因子的影响

The influences of insulin resistance on endothelins,Von Willebrands factorin patients with coronary heart disease after percutaneous coronary intervention

目的探讨胰岛素抵抗对冠心病患者经皮冠状动脉介入治疗(PCI)术后血浆内皮素(ET)与血管性假性血友病因子(vWF)的影响。方法选择96例冠心病患者分别测定空腹血糖(FSG)、空腹胰岛素(FSI)、内皮素(ET)、血管性假性血友病因子(vWF),并计算胰岛素敏感性指数[ISI,ISI=1/(FSG×FSI)]。将96例冠心病患者分为胰岛素抵抗组(IR组)和非胰岛素抵抗组(NIR组),均行经皮冠状脉球囊成形术(PT-CA)及支架植入术,分别于PCI术前、术后30min、4h、12h、24h、48h、72h、7d取外周静脉血,编码血浆标本,在-80℃条件下保存,分批检测ET及vWF。并连续观察PCI前后血浆ET及vWF变化,并对其与ISI之间相互关系进行分析。结果(1)IR组、NIR组患者vWF水平与术前比较,术后30min增高分别为:(161±42)%、(124±42)%,至4h达峰值分别为:(279±38)%、(207±37)%,并持续增高7d。IR组术前后各时间点vWF水平较NIR组差异均有统计学意义(P均<0.05)。(2)IR组、NIR组患者血浆ET水平与术前比较,术后30min迅速增高并达峰值分别为:(35±7)ng/ml、(26±10)ng/ml,以后逐渐下降,72h下降到术前水平。IR组术前后各时间点ET水平较NIR组差异均有统计学意义(P均<0.05)。(3)PCI术后参数间相关性PCI术后ISI与vWF水平增高程度呈明显负相关(r=-0.508,P<0.01);PCI术后ISI与ET水平增高程度呈明显负相关(r=-0.587,P<0.01)。结论PCI术后IR与内皮功能障碍相互作用,共同加重内皮功能的损伤。PCI术后vWF水平、ET水平、ISI的监测可能为预测PCI早期及晚期并发症提供理论依据。

Objective To study the effect of insulin resistance on endothelin （ET）, Von Willebrand＇s factors （vWF） concentration in patients with coronary heart disease （CHD）after percutaneous coronary intervention. Methods The fasting serum glucose（,FSG）,fasting seruminsulin （FSI）, ET and vWF were measured in 96 patients with coronary heart disease and insulin sensitivity index （ISI） was calculated.96 patients were divided into insulin resistance group（IR group） and non-insulin resistance group（ NIR group）. Peripheral blood samples for measurement of EF, vWF were taken immediately before PCI,immediately after PCI, 30 min,4 h, 12 h,24 h,48 h,72 h,7 d after PCI respectively. Ceded plasma samples were stored at - 80℃ and analyzed in two batch at the study.96 consecutivepatients underwent PCI.The pre and post-procedural levels of plasma ET and vWF were examined to investigatethe correlation between ISI and the change of levels of ET and vWF. Results （1）The plasma concentrations of vWF and ET were significantly higher in NIR and IR groups after PCI than those before PCI. （2） The peak levels of vWF （278.87±37.57） %, ET （34.78±10.75） ng/ml were at 4 hours,30min respectively in IR group after PCI. （3）The increase of the plasma concentrations of vWF, ET in IR group were significantly higherthan those in NIR group after PCI. After PCI ET and vWF were correlated with ISI.（ r = -0.587, P 〈0.01; r = -0.508, P 〈 0.01,respectively）.Conclusion After PCI IR interacts with dysfunction of endothelium, which aggravates the injury of endothelium function. After PCI the surveillance of levels of vWF and ET may offer theoretical basis for predicting the complications of PCI at early or late periods.