摘要
目的探讨糖耐量正常且伴发急性ST段抬高型心肌梗死患者胰岛素抵抗与梗死相关动脉早期血流自发再通的关系。方法连续入选141例糖耐量正常且伴发急性ST段抬高型心肌梗死患者，根据急诊冠状动脉造影结果分为TIMI 0～1级组（91例）和TIMI2～3级组（50例）。计算病变支数和Gensini得分，测定代谢参数和hs-cRP，计算胰岛素抵抗指数（IRI），进行相关统计分析。结果血流TIMI 0—1级组的空腹胰岛素[（11．52±6．22）mU／L]、IRI（2．79±2．32）和Gensini得分[（59．17±26．95）分]显著高于TIMI 2～3级组[（7．54±3．65）mU／L、（1．73±1．26）和（38．46±22．74）分]（P均〈0．01）。IRI和Gensini得分呈显著正相关（r=0．185，P〈0．05）。Logistic回归分析提示，IRI是影响梗死相关动脉血流自发再通的独立危险因素（OR=2．87，95％CI为1．09～7．57，P〈0．05）。结论胰岛素抵抗是影响糖耐量正常且伴发急性ST段抬高型心肌梗死患者梗死相关动脉早期血流自发再通的独立危险因素。
Objective To clarify the role of insulin resistance on spontaneous recanalization of infarct-related arteries in the early phase of acute ST-elevation myocardial infarction （STEMI） in patients with normal glucose tolerance. Methods 141 consecutive patients with normal glucose tolerance and acute STEMI were enrolled in our study. Subjects were divided into TIMI 0-1 group （n = 91 ） and TIMI 2-3 group （n = 50） by primary coronary angiography （CAG）. The Gensini score and 0-3-vessel disease score estimated the severity and extent of coronary artery disease （CAD）. Metabolic parameters and homeostasis model assessment for insulin resistance （IRI） were determined. Results Serum level of fasting insulin, IRI and Gensini score were higher in TIMI 0-1 group than in TIMI 2- 3 group [ （ 11.52 ± 6.22） mU/L vs （7.54 ± 3.65） mU/1, （2.79 ± 2.32） vs （ 1.73 ± 1.26）, （59.17 ± 26.95 ） vs （ 38.46 ± 22.74 ） （ P 〈 0.01 ） ]. IRI was positively associated with Gensini score （ r = 0. 185 ,P 〈 0.05 ）. Multivariate Logistic regression analysis revealed that IRI was independent risk factor influencing spontaneous recanalization of infarct-related arteries（ OR = 2.87,95% CI = 1.09-7.57, P 〈 0.05 ）. Conclusion Insulin resistance is independent risk factor influencing spontaneous recanalization of infarct-related arteries in the early phase of acute STEMI in patients with normal glucose tolerance.
出处
《中国综合临床》
2009年第5期475-477,共3页
Clinical Medicine of China
