不同类型冠心病的胰岛素抵抗及危险因素分析

COMPARATIVE STUDY ON INSULIN RESISTANCE IN PATIENTS WITH VARIOUS TYPES OF CORONARY HEART DISEASE AND THE ANALYSIS OF DANGEROUS FACTORS OF CORONARY HEART DISEASE

目的：比较不同类型冠心病（ＣＨＤ）的胰岛素抵抗（ＩＲ）程度和分析ＣＨＤ的危险因素。方法：检测急性心肌梗死（ＡＭＩ）８１例，不稳定型心绞痛（ＵＡ）８２例，稳定型心绞痛（ＳＡ）８５例和对照组１２７例糖耐量、胰岛素（ＩＳ）和Ｃ肽（ＣＰ释放试验、空腹血脂等，并以餐后血糖（ＢＧ）、ＩＳ和ＣＰ及血压等１０个变量进行Ｌｏｇｉｓｔｉｃ回归分析。结果：ＵＡ组舒张压（ＤＰ）显著高于对照组（Ｐ〈０．０１），ＳＡ组ＤＰ明显高于对照组（Ｐ〈０．０５）；ＵＡ组ＣＨ明显高于ＳＡ组和对照组（Ｐ〈０．０５）；ＡＭＩ组服糖后３ｈＢＧ、ＵＡ组２ｈ、３ｈＢＧ均明显高于对照组（Ｐ〈０．０５）；ＵＡ组１ｈＩＳ明显高于对照组（Ｐ〈０．０５）；ＡＭＩ组服糖后２ｈ、３ｈＣＰ／ＢＧ分别明显高于对照组和ＳＡ组（Ｐ〈０．０５）；

Objective:To compare the difference of insulin resistance(IR) in patients with various types of coronary heart disease(CHD) and analyse the dangerous factors of CHD.Methods:Blood glucose(BG),insulin (IS),C-peptide (CP) levels during oral glucose toleratance test (OGTT) and cholesterol (CH),triglyceride (TG),high density lipoprotein (HDL) were measured in 81 patients with acute myocardial infarction (AMI),82 patients with unstablb angina pectoris (UA),85 patients with stable angina pectoris (SA) and 127 control subjects (CO).Ten variates (BG,IS and CP after OGTT and blood pressure) were studied with Logistic regression.Results:The diastolic pressure (DP) in UA group was higher significantly than in CO group (P<0.01),DP in SA group was higher than in CO group (P<0.05);CH in UA group was higher than in SA group and in CO group (P<0.05);BG appeared significantly increased in AMI group at 3 hour and BG in UA group at 2 and 3 hour postload during OGTT compared with CO group (P<0.05);IS in UA group at 1 hour postload during OGTT was higher than in CO group (P<0.05);CP/BG in AMI group at 2 and 3 hour postload during OGTT was higher than in CO group and SA group (P<0.05);BG at 3 hour postload during OGTT and DP were sieved as the independent danger factors of CHD.Conclusion:Glucose to lerance in patients with CHD is reduced.There are IR and hyperinsulinemia in patients with CHD,the IR in patients with AMI is more serious than in patients with SA IR has close correlation with blood-fat metabolism,BG at 3 hour postload during OGTT and DP are independent danger factors of CHD.