冠心病合并代谢综合征危险因素患者胰岛素抵抗与氧化应激的关系

The relationship between oxidative stress and insulin resistance in coronary heart disease

目的通过检测冠心病患者氧化应激水平并与胰岛素敏感指数及冠状动脉病变进行相关分析,探讨氧化应激在胰岛素抵抗致动脉粥样硬化形成中的作用。方法收集经冠状动脉造影证实,至少有一支血管狭窄≥50%的56名冠心病患者为观察组,依据合并危险因素(超重、高血压、糖耐量异常/糖尿病、高甘油三酯血症、低高密度脂蛋白)的数目分为单纯冠心病组11例,冠心病合并1-2个危险因素组12例,冠心病合并3-5个危险因素组33例,以同期在心内科住院冠状动脉造影正常者19人为对照组。测定各组血糖、血脂、胰岛素水平,计算胰岛素敏感指数。比色法测定SOD及MDA水平,对胰岛素敏感指数、氧化应激水平及冠状动脉病变程度进行相关分析。结果随着伴随危险因素个数的增加,胰岛素敏感指数进行性下降,冠状动脉病变程度加重。同时SOD明显降低,MDA明显增高,SOD与ISI正相关,MDA与ISI负相关。结论随着冠心病患者伴随危险因素个数的增加,胰岛素抵抗程度增加,冠状动脉病变程度也呈增加趋势,胰岛素抵抗可能通过进一步加强机体的氧化应激水平促进动脉粥样硬化的形成。

Objective To investigate the role of oxidative stress in the development of atherosclerosis of insulin resistance.Methods 56 patients with at least one vessel ≥50% luminal narrowing were analyzed.According to complicated metabolic syndrome risk factors divided as coronary heart disease group(CHD),CHD with 1-2 risk factor group(CHD+ MS1-2) and CHD with 3-5 risk factors(CHD+MS3-5)group,19 healthy subjects as control group.All recipients were measured superoxide dismutase(SOD)、malondialdehyde(MDA)、and insulin sensitive index(ISI).Results The plasma level of SOD were significantly decreased,while MDA was significantly elevated in patients with CHD、CHD+MS1-2 and CHD+MS3-5 group compared with control group,there were significant difference among CHD group CHD+MS1-2 group and CHD+MS3-5 group.The ISI level decreased significantly in CHD+MS1-2 and CHD+MS3-5 group,and associated with the extent and the severity of coronary lesions.There was positive correlation between ISI and SOD(r=0.277,P<0.05)and negative correlation between ISI and MDA(r=-0.285,P<0.05).Conclusions Oxidative stress may play an important role during insulin resistance,which results to the development of atherosclerosis.