尿微量白蛋白及胰岛素抵抗与急性冠状动脉综合征的关系

Association of microalbuminuria and insulin resistance with acute coronary syndrome

目的探讨尿微量白蛋白、胰岛素抵抗与急性冠状动脉综合征（ACS）患者冠状动脉病变严重程度的关系，对患者近期预后的预测价值。方法连续收集2008年1月至2009年6月在我院心内科住院并诊断为ACS患者162例，按尿白蛋白排泄率（UAER）水平分为3组：正常组（UAER〈20μg／min）54例、微量白蛋白尿组（UAER20～200μg／min）62例、大量白蛋白尿组（UAER〉200μg／min）46例，分析3组患者间胰岛素抵抗指数、冠状动脉病变严重程度的差异，并观察尿微量白蛋白及胰岛素抵抗对接受经皮冠状动脉介入治疗（PCI）后ACS患者近期（6个月）主要心脏不良事件的影响。结果随着UAER增高，3组患者胰岛素抵抗指数升高，且冠状动脉病变的严重程度逐渐增高，组间差异有统计学意义（P〈0．05或〈0．01）；尿微量白蛋白与胰岛素抵抗存在相关性（r=0．366，P〈0．01）；多因素logistic回归分析显示，尿微量白蛋白及胰岛素抵抗均是ACS患者PCI术后6个月内主要心脏不良事件发生的独立预测因子。结论尿微量白蛋白及胰岛素抵抗与ACS患者冠状动脉病变严重程度有关，尿微量白蛋白及胰岛素抵抗对ACS患者的近期预后有一定的预测价值。

Objective To investigate relationship of microalbuminuria （MAU） and insulin resistance （IR） to severity of coronary lesions in patients with acute coronary syndrome （ACS）, and its predictive value for short-term prognosis in them. Methods In total, 162 ACS patients admitted to the department of cardiology, Guangzhou First People＇s Hospital, Guangzhou, Guangdong province during January 2008 to June 2009 were selected and divided into three groups according to their urine albumin excretion rate （UAER） ： 54 cases in normal group with UAER less than 20 μg/min, 62 cases in microalbaminuria group with UAER of （20 -200） μg/min, and 46 cases in mass-albuminuria group with UAER more than 200 μg/min. Difference in IR （by homeostasis model assessment, HOMA） and severity of coronary lesions among the three groups was assessed. Effects of baseline MAU and IR on main adverse cardiac events within the recent six months were observed in ACS patients after percutaneous coronary intervention （PCI）. Results IR increased and coronary lesions aggravated as UAER increasing in all the three groups of ACS patients （P 〈 0. 05 or P 〈 0. 01 ）. MAU associated with IR, with a coefficient of correlation of 0. 366 （ P 〈 0. 01 ）. Results of multivariate logistic regression analysis showed that both MAU and IR were strong independent predictors for main adverse cardiac events in ACS patients within six months after PCI. Conclusions MAU and IR associate with severity of coronary lesions in ACS patients, suggesting certain predictive value for main adverse cardiac events in short-term after PCI.