老年收缩性和舒张性心衰患者胰岛素抵抗与炎症因子的相关研究

Insulin resistance and inflammatory activation in older patients with systolic and diastolic heart failure

目的探讨老年收缩性(SHF)和舒张性心衰(DHF)患者胰岛素抵抗与炎症因子的关系。方法收集94例住院老年SHF和DHF非糖尿病患者及48例正常对照者,用心脏超声确定心衰分类,同时测定空腹血糖(FBG)、早餐后2h血糖(2hBG)、血脂、空腹胰岛素(FNS)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF2α)、白介素6(IL-6)。根据HOMA Model计算胰岛素抵抗指数(IRI)。结果与对照组相比,DHF组IRI、FNS明显升高,差异有极显著意义(P<0.01),SHF组差异有显著意义(P<0.05)。两组CRP、IL-6、TNF2α水平均较正常对照组显著升高,差异有极显著意义(P<0.01)。结论胰岛素抵抗与炎症因子的水平增高共同参与了老年SHF和DHF的发生及病情的进展。

Objective To evaluate insulin resistance and systemic inflammation in older patients with systolic （SHF） or diastolic heart failure （DHF）. Methods 94 non-diabetic hospitalised older patients with chronic heart failure were studied, together with a control group of 48 older healthy volunteers. On the basis of Doppler echocardiographic criteria, patients were classed as having SHF or DHF. Fasting glucose, insulin, C reactive protein, interleukin 6, and tumour necrosis factor a soluble receptor Ⅱ （TNF2α） concentrations were determined. Insulin resistance was estimated by the homeostasis model assessment （HOMA）. Results HOMA index and insulin was higher in patients with DHF than healthy volunteers （P〈0. 01）,in patients with SHF （P〈 0. 05）. C reactive protein,interleukin 6, and TNF-aSRII were all significantly （P 〈 0. 01） higher in patients with DHF and SHF than in healthy volunteers. Conclusion Insulin resistance and inflammatory activation are present in older patients with SHF and DHF.