同型半胱氨酸与胰岛素抵抗在冠心病发病中的作用

Implication of Homocysteine and Insulin Resistance in Pathogenesis of Coronary Artery Disease

目的探讨同型半胱氨酸（HCY）与胰岛素抵抗（IR）在冠心病发病及急性心肌梗死发生中的作用。方法527例患者根据冠脉造影、临床表现及辅助检查分为对照组（237例）、心绞痛组（172例）、急性心肌梗死组（118例）。测定血HCY、空腹血糖、空腹胰岛素、血脂。用自我平衡模型分析法（HOMA）指数（IRI）评价胰岛素抵抗，进行相关数据分析。结果心绞痛组与心肌梗死组患者的HCY、空腹血糖、空腹血浆胰岛素、IRI及IRI≥2．69比例均明显高于对照组（P〈0．05）；心肌梗死组患者的IRI高于心绞痛组（P〈0．05）。多因素Logistic[~归分析显示，吸烟、高HCY血症、IRI≥2．69、低密度脂蛋白〉2．6mmol／L为冠心病发病的独立危险因素；男性、吸娴、IRIi〉2．69、低密度脂蛋白〉2．6mmol／L为急性心肌梗死的独立危险因素。HCY与IRI呈明显正相关（P〈0．01）。结论HCY与IR具有相关性，二者均为冠心病发病及急性心肌梗死发生的危险因素。

Objective To explore the role of homocysteine（HCY） and insulin resistance（IR） in pathogenesis of coronary artery disease（CAD）.Methods A total of 527 patients with chest complaint were divided into control group（n=237）,angina group（n= 172） and acute myocardial infarction（AMI） group（n= 118） by clinical manifestation and coronary angiography.Metabolic parameters and homeostasis model assessment for IR（IRI） were measured. Predictors of CAD and AMI were determined by multivariate regression analysis.Results HCY, fasting blood glucose,plasma insulin,IRI were significantly higher, and IRI/〉 2.69 were more common in angina and AMI group. IRI was significantly higher in AMI group than in angina group.Multivariate regression analysis revealed that smoking,hyperhomocysteinemia,IR,and low density lipoprotein 〉 2.6mmol/L were independent risk factors for CAD.Male,smoking,IR,and low density lipoprotein 〉 2.6mmol/L were independent risk factors for AMI.HCY was positively associated with IRI.Conclusion HCY was associated with IR,and both of them were risk factors for CAD and AMI in non-diabetic patients.