冠状动脉临界病变与胰岛素抵抗的关系

Correlation between intermediate coronary lesion and insulin resistance

目的研究冠状动脉临界病变患者硬化斑块稳定性与胰岛素抵抗指数之间的关系。方法利用血管内超声的方法检测了71例患者冠状动脉中斑块的稳定性,并将患者分为稳定斑块组和不稳定斑块组。抽取两组患者血液,利用自动生化仪检测了患者血清中总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(HDL-C)及超敏C反应蛋白(highsensitivity C-reactive protein,hs-CRP)的浓度,并利用酶联免疫吸附测定法(high-density lipoprotein cholesterol,ELISA)检测血清中白细胞介素-1、白细胞介素-8、基质金属蛋白酶(MMP-9)等炎症因子的浓度,同时检测了空腹血糖(FPG)、空腹胰岛素(FINS)的浓度并计算胰岛素抵抗指数(IRI)和体质量指数(BMI)。结果与对照组比较,冠状动脉临界病变患者血清TC、TG、LDL-C和hs-CRP浓度升高及HDL-C浓度降低,差异有统计学意义(P<0.05);并且患者炎症因子浓度和胰岛素抵抗指数也明显高于对照组,差异有统计学意义(P<0.05)。在冠状动脉临界病变患者中,不稳定斑块组比稳定斑块组血清TC、TG、LDL-C和hs-CRP浓度更高而HDL-C浓度则更低,差异有统计学意义(P<0.05);同时,不稳定斑块组炎症因子浓度、胰岛素抵抗指数和体质量指数也明显更高,差异有统计学意义(P<0.05)。结论冠状动脉临界病变患者体内脂代谢、炎症因子浓度、胰岛素抵抗指数及体质量指数与不稳定斑块的形成具有密切的联系,其中具体机制还需进一步阐明。

Objectives To investigate the correlation between plaque stability and insulin resistance in patients with intermediate coronary lesion. Methods Plaque stabilities in 71 patients with intermediate coronary lesion were detected by intravascular ultrasound;accordingly,71 patients were divided into stable plaque group and unstable plaque group. Serum concentrations of total cholesterol （TC）, triglyceride （TG）, low-density lipoprotein cholesterol （LDL-C）, high- density lipoprotein cholesterol （HDL-C） and high-sensitivity C-reactive protein （hs-CRP） in patients and normal controls were analyzed by automatic biochemical analyzer. In addition, serum concentrations of interleukin （IL）-1, IL-8 and matrix metalloproteinase-9 were detected by enzyme-linked immunosorbent assay （ELISA）. Fasting plasma glucose （FPG） and fasting insulin （FINS） were measured. Insulin resistance index （IRI） together with body mass index （BMI） were calculated. Results Compared with control group, patients with intermediate coronary lesion had obviously elevated serum concentrations of TC,TG,LDL-C and hs-CRP as well as decreased serum concentration of HDL-C （P〈0.05）. Concentrations of inflammatory factors and IRI in patients were also significantly higher than those of controls （P〈0.05）. Compared with stable plaque group, serum concentrations of TC, TG, LDL-C and hs-CRP significantly elevated, while HDL-C decreased in unstable plaque group （P〈0.05）. Furthermore, concentrations of inflammatory factors, IRI and BMI were also significantly higher in unstable plaque group （P〈0.05）. Conclusions Formation of unstable plaque is closely related to lipid metabolism, concentrations of inflammatory factors, IRI and BMI in patients with intermediate coronary lesion. However, the mechanism remains unclear and deserves further elucidation.