冠心病患者红细胞胰岛素酶活性与胰岛素受体检测及其意义

Significance of determination of insulinase activity and insulin receptor of erythrocytes in patients with coronary artery disease

目的为探讨冠心病患者的胰岛素抵抗（ＩＲ）与其红细胞胰岛素酶活性（ＥＩＡ）及红细胞胰岛素受体（ＥＩＲ）的关系。方法检测５４例冠心病患者及３０例健康人的ＥＩＡ、ＥＩＲ及相关指标，并计算胰岛素敏感性指数（ＩＳＩ）。结果冠心病患者的ＥＩＡ、空腹血浆胰岛素水平（ＦＩＮＳ）、血浆总胆固醇（ＴＣ）、血浆甘油三酯（ＴＧ）及低密度脂蛋白（ＬＤＬ）水平显著高于正常对照组（Ｐ＜００１），而低亲和力ＥＩＲ位点数、ＩＳＩ、血浆高密度脂蛋白胆固醇组分２（ＨＤＬ２）显著低于正常对照组（Ｐ＜００１）。伴非胰岛素依赖型糖尿病及高血压的冠心病患者与不伴这些疾病的冠心病患者相比，前者的ＥＩＡ、ＦＩＮＳ高于后者，而ＩＳＩ低于后者（Ｐ＜００１或Ｐ＜００５）。相关分析表明，冠心病患者的ＥＩＡ与ＦＩＮＳ、ＴＧ显著正相关，与低亲和力ＥＩＲ位点数及ＩＳＩ呈显著负相关，患者的低亲和力ＥＩＲ位点数与ＦＩＮＳ及ＴＧ呈负相关。结论（１）冠心病患者存在胰岛素抵抗；（２）冠心病患者的胰岛素抵抗可能与其胰岛素酶活性及胰岛素受体活性异常有关；（３）红细胞胰岛素酶活性和红细胞胰岛素受体也许可以一定程度地反映机体的胰岛素敏感性。

Objective To investigate the relationship among insulin resistance (IR), insulinase activity of erythrocytes (EIA) and insulin receptor of erythrocytes (EIR) in patients with coronary artery disease (CAD).Methods EIA, EIR and related indices were determined and insulin sensitivity index (ISI) was calculated in 54 CAD patients.Results In CAD patients, EIA, fasting plasma insulin (FINS), plasma total cholesterol (TC), plasma triglycerides (TG) and low density lipoprotein (LDL) level were higher and low affinity EIR, ISI and high density lipoprotein subclass 2 (HDL 2) were lower than those in healthy controls. Moreover, in the CAD patients with non insulin dependent diabetes mellitus (NIDDM) and essential hypertension (EH), EIA, FINS were increased, and ISI were decreased as compared with the CAD patients without EH and NIDDM. Correlation analysis showed that EIA was positively correlated with FINS and TG and inversely correlated with low affinity EIR and ISI in CAD patients. In CAD patients, low affinity EIR was inversely correlated with FINS and TG. Conclusions (1) The CAD patients have IR; (2)The abnormal insulinase activity and insulin receptor may play a role in the onset of IR in CAD patients; (3) EIA and EIR may be used to estimate the insulin sensitivity.