胰岛素敏感性和血脂水平与冠状动脉病变程度相关性

Correlation of insulin sensitivity and blood lipid with the severity of coronary artery disease

目的:探讨冠心病患者胰岛素敏感性和血脂水平与冠状动脉病变范围及程度的关系。方法:检测100例冠状动脉造影阳性患者(冠心病组)、50例冠状动脉造影阴性患者(阴性组)和50例健康者(对照组)的空腹血脂、血糖、胰岛素浓度及胰岛素敏感性指标。分别以冠状动脉狭窄分数和病变冠状动脉支数为因变量,血脂、血糖、胰岛素和胰岛素敏感性指标为自变量,进行单元直线相关分析和多元逐步回归分析。结果:冠心病组与对照组除总胆固醇、血糖外,血脂、胰岛素和胰岛素敏感性差异均有统计学意义(P<0.05);冠心病组仅有高密度脂蛋白和胰岛素敏感性指数明显低于阴性组(P<0.05)。冠心病组胰岛素和胰岛素敏感性指数与冠状动脉狭窄分数显著相关(r=0.25,P<0.05;r=-0.32,P<0.01),病变冠状动脉支数与任何自变量无相关性。逐步回归分析显示,胰岛素敏感性指数与冠状动脉病变程度独立相关。结论:冠心病存在胰岛素抵抗、高胰岛素血症和血脂尤其是高密度脂蛋白异常,均为冠心病发病危险因素;胰岛素敏感性指数是影响冠状动脉病变程度独立影响因子。

Objective To investigate the relationship of insulin sensitivity and blood lipid with the extent and severity of coronary artery lesions in patients with coronary heart disease. Methods Blood lipid, fasting glucose, fasting insulin and insulin sensitivity parameters were determined in 100 patients with positive coronary angiography results （coronary heart disease group）, 50 patients with negative coronary angiography results （non-coronary heart disease group） and 50 healthy controls. Correlation of the severity of coronary artery lesions with blood lipid, glucose, insulin and the insulin sensitivity parameters was respectively studied with linear regression analysis, and the stepwise regression analysis was used to assess independence of associations. Results Blood lipid, insulin and insulin sensitivity index except for total cholesterol and glucose had statistic difference between coronary heart disease group and control group （P〈0.05）. High density lipoprotein and insulin sensitivity index were significantly lower in coronary heart disease group than those in non-coronary heart disease group. Insulin and insulin-sensitivity index in coronary heart disease group were remarkably correlated with the severity of coronary artery lesions （r=0.25, P〈0,05; r=-0.32, P〈0.01）. The number of diseased vessel was not correlated with any independent variables. Stepwise regression analysis showed that only insulin sensitivity index was independently correlated with the severity of coronary lesions. Conclusion The coronary heart disease presents the insulin resistance, hyperinsulinism and lipid metabolism abnormity, which are all the risk factors of coronary heart disease. Insulin sensitivity index is the only independently variable correlated with the severity of coronary lesions.