尿微量白蛋白和胰岛素抵抗在非糖尿病患者冠心病发病中的作用

Role of microalbuminuria and insulin resistance in pathogenesis of coronary artery disease of patients without diabetes

目的探讨尿微量白蛋白(mAlb)和胰岛素抵抗(IR)在非糖尿病患者冠心病发病中的作用。方法 630例具有胸痛、胸闷症状的非糖尿病患者,根据冠脉造影结果分为冠心病组(374例)和对照组(256例)。测定mAlb、血糖(Glu)、胰岛素(Ins)、血脂和血肌酐(SCr),计算胰岛素抵抗指数(IRI)。结果冠心病组患者的mAlb、Glu、Ins、SCr、IRI高于对照组,冠心病组的男性、高血压、吸烟、mAlb>20mg/L、IRI≥2.69的比例均显著高于对照组(P<0.05或P<0.01)。多因素Logistic回归分析提示,高龄、男性、吸烟、mAlb>20mg/L、IRI≥2.69为冠心病发病的独立危险因素(P<0.05)。mAlb与IRI呈正相关(P<0.05)。结论 mAlb与IR具有相关性,两者均为冠心病发病的危险因素。

Objective To explore the role of microalbuminuria（mAlb） and insulin resistance（IR） in the pathogenesis of coronary artery disease（CAD） of non-diabetic patients. MethodsAccording to coronary angiography,630 consecutive non-diabetic patients with chest complaint were divided into two groups of CAD（374 cases,with CAD） and C（256 cases,without CAD）.The CAD-related metabolic parameters were measured and IR index（IRI） was calculated. Results Fasting blood glucose,plasm insulin,IRI,mAlb,serum creatinine were significantly higher in group CAD than those in group C and the percentages of male,hypertension,smoking,mAlb20mg/L and IRI≥2.69 were more in group CAD than those in group C（P〈0.05 or P〈0.01）.Multivariate regression analysis revealed that age,male,smoking,mAlb and IR were the independent risk factors for CAD in non-diabetic patients.mAlb was positively correlated with IRI.Conclusion mAlb is closely associated with IR,both of which are the risk factors for CAD in non-diabetic patients.