医源性胰岛素对2型糖尿病患者发生冠脉事件的观察

Effects of remedy given-insulin with different dosage on trigger action of coronary events in middle aged type-2 diabetes mellitus

目的探讨医源性胰岛素不同剂量对中年2型糖尿病患者合并冠脉事件发生是否关联。方法对53例使用胰岛素治疗的中年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,结合冠状动脉造影检查,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。结果糖尿病合并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30 IU以上;冠脉事件组胰岛素及C肽含量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;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。结论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 Fifty-three middle-aged type-2 diabetes mellitus cases who were 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 repeetively analysed using linear regression study. And another 32 type-2 diabetes mellitus without insulin regimen were placed in control group. Samples were analyzed with immunoreactiveinsulin and C peptides. The correlation between these variety 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 （hose 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 consistance. Stepwise regression analysis showed that insulin and C peptide were independently correlated with the severity of coronary lesions. Conclusion The severity of coronary lesions significandy 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 cor onary lesion events.