外源性胰岛素对2型糖尿病患者发生冠脉事件的作用观察

Effects of remedy given insulin with different dosage inducing coronary events in type-2 diabetes mellitus

目的探讨医源性胰岛素对2型糖尿病患者合并冠脉事件发生是否存在相关的关系。方法对113例使用胰岛素治疗的2型糖尿病并伴发冠脉事件的患者进行血清胰岛素和C肽测量,均行冠状动脉造影检查。分别以病变冠状动脉记分和病变冠状动脉支数为因变量,血清胰岛素和C肽测量为自变量,进行单元直线相关分析和多元逐步回归分析。另选82例未用胰岛素的2型糖尿病患者作为对照组。结果伴发冠脉事件组血清胰岛素水平显著高于对照组,该组患者日均胰岛素用量多数在30IU以上。冠脉事件组胰岛素及C肽与病变冠状动脉记分呈显著正相关,病变冠状动脉支数与血清胰岛素和C肽呈正相关,并有浓度递增关系。逐步回归分析显示血清胰岛素和C肽与冠状动脉病变程度独立相关。结论冠状动脉病变程度与胰岛素及C肽呈正相关。血清胰岛素和C肽与冠状动脉病变程度独立相关。医源性胰岛素的剂量对2型糖尿病合并冠状动脉事件的病理生理急性改变存在显著的相关关系。

Objective To explore the effects of remedy given insulin with a different dosage on the onset of coronary events in middle aged type 2 diabetes mellitus. Methods One hundred and thirteen type-2 diabetes mellitus cases received insulin treatment with coronary heart disease were processed with insulin and peptic C measured and angiography. The coronary lesions and involved vessel score were repectively analysed using linea regression study. And another 82 type-2 diabetes mellitus without insulin regimen were placed in control group. Samples were analyzed with immunoreactiveinsulin and C peptides. Correlation between these veriaty scores for coronary lesions and 3 insulin sensitivity parameters was respectively obtained using linear regression analysis,and the stepwise regression analysis was used to assessing dependence of associations. Results Serum insulin levels in coronary events group was significantly higher than those in control group. Most patients in coronary group consumed insulin more than 30 IU each day. Insulin and C peptide in coronary group was correlated with coronary lesion score or diseased vessel score. And the correlation was still significant with the insulin consumed consistence. Stepwise regression analysis showed that insulin and C peptide were in dependently correlated with the severity of coronary lesions. Conclusion The severity of coronary lesions significattly correlates with insulin and C peptide. Remedy given hyperinsulinimia is only independently correlated variable in coronary events trigger in those type 2 diabetes mellitus. There might be certain some association in the acute pathophysiology process of coronary lesion events.