冠心病患者冠状动脉病变程度与胰岛素抵抗的相关性研究

Study on the Relationship between Insulin Resistance and Coronary Lesion in Patients with Coronary Heart Disease

目的:探讨冠心病(CHD)患者不同冠状动脉(冠脉)病变程度与胰岛素抵抗(IR)的关系。方法:128例冠脉造影检查者,根据冠脉病变支数,分为单支病变组、双支病变组、多支病变组和正常对照组。测量血压、身高、体重、腰围(WC)和臀围。抽取空腹静脉血,测定血浆胰岛素(FINS)、血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(Apo-A1)和载脂蛋白B(Apo-B)。计算体重指数(BMI)、腰臀比(WHR)、HOMA-胰岛素抵抗指数(HOMA-IR)和Gensini积分。结果:CHD各组HOMA-IR和FINS均显著高于对照组(P<0.05)。在CHD各组,随冠脉病变支数和Gensini积分增加,HOMA-IR和FINS也增加。HOMA-IR与SBP、DBP、WC、BMI、WHR、TC、LDL-C、Apo-B、FPG、FINS、Gensini积分均呈显著正相关(P<0.05)。校正年龄、血压、血糖、血脂、肥胖等影响后,HOMA-IR仍与Gensini积分呈显著正相关(P<0.01)。线性回归分析显示Gensini积分、BMI、FPG是影响HOMA-IR的独立因素;FINS、BMI、HOMA-IR、年龄、DBP是影响Gensini积分的独立因素。结论:CHD患者存在IR,CHD患者的IR状态与冠脉病变程度密切相关。

Objective：To explore the relationship between insulin resistance and various coronary lesion degree in patients with coronary heart disease（CHD）. Methods：Totally 128 patients confirmed by coronary angiography were enrolled . They were divided into four groups according to the number of diseased vessel, one vessel disease group, two vessels disease group, three vessels disease group and normal control group. The blood pressure, height, weight, waist circumference（WC）and hip were measured. Plasma insulin（FINS）, fastingplasmaglucose（FPG）, total cholesterol（TC）, triglyceride（TG）, high-density lipoprotein cho- lesterol（HDL-C）, low-densitylipoproteincholesterol（LDL-C）, apoprotein-A1 （Apo-AI）, apoprotein-B（Apo-B）, body mass index （BMI） and waist-hip ratio（ WHR） were measured. Homeostasis model assessment of insulin resistance index（HOMA-IR） and Gensinirs score of coronary stenosis were also calculated. Results： HOMA IR and FINS in CHD groups were significantly higher than those in the control group（P〈0.05 ）. In CHD groups ,with the number of the coronary artery disease and the Gensini＇s score increasing, the HOMA-IR and FINS were becoming higher and higher. HOMA-IR were positively and significantly correlated with SBP, DBP, WC , BMI, WHR, TC, LDL-C, Apo-B, FPG, FINS and Gensini＇s score（P〈0.05 ）. After adjusting the influential factors such as age,blood pressure, blood glucose,blood lipids and obesity, HOMA-IR was positively correlated with Gensini＇s score（P〈0.01 ）. Multivariate linear regression model showed that Gensini＇s score, BMI and FPG were independent factors for HOMA-IR while FINS, BMI, HOMA-IR, age and DBP were independent factors for Gensinirs score. Conclusion：Insulin resistance is found in patients with CHD and closely correlated with the severity of coronary artery stenosis.