非糖尿病、非肥胖患者胰岛素敏感性与冠状动脉病变严重程度的相关性分析

Correlation of severity of coronary artery disease with insulin sensitivity in non-diabetic and non-obese patients

目的:探讨非糖尿病、非肥胖患者胰岛素敏感性与冠状动脉疾病严重程度的相关性。方法:连续入选自2013年3月至2014年3月,因胸闷、胸痛症状入院接受冠状动脉造影的非糖尿病、非肥胖患者483例。根据稳态模型胰岛素抵抗指数(HOMA-IR)定义胰岛素抵抗(IR)组(n=118)和胰岛素敏感组(n=365)。通过冠状动脉造影确定的病变血管数目和SYNTAX积分评价冠状动脉病变的广泛性和严重程度。结果:IR患者年龄偏小[(57.1±10.4)vs.(59.5±9.4)岁,P=0.02]、平均BMI水平高[(27.1±2.8)vs.(25.1±2.8),P=0.001]、高血压(72.9%vs.57.5%,P=0.03)和超质量(76.3%vs.50.7%,P=0.00)发生率高。IR患者冠状动脉无病变比例低(14.4%vs.23.3%,P=0.04),2支或以上血管病变比例高(50%vs.36.7%,P=0.01),平均SYNTAX积分[8(5,15)vs.7(2,12)]以及SYNTAX积分高分组(SYNTAX≥10)的比例增高,差异有统计学意义。在控制多种冠心病传统危险因素后,偏相关分析显示HOMA-IR与病变血管数目(r=0.23,P=0.00)、SYNTAX积分(r=0.20,P=0.01)、支架数目(r=0.17,P=0.02)呈正相关。结论:在非糖尿病、非肥胖患者,胰岛素敏感性下降与冠状动脉病变的广泛性和严重性密切相关,可以作为识别高危患者的工具;改善IR状态可以作为冠状动脉疾病治疗策略的新靶点。

Objective：Insulin sensitivity decreased or insulin resistance （IR） has known to be associated with coronary artery disease （ CAD）, but the assessment of severity of the CAD based on IR in non-diabetes mellitus has not been established in detail. The aim of our study was to investigate the correlation between Insulin sensitivity and the severity of angiographic characteristics of coronary atherosclerosis in non-diabetic and nonobese patients. Methods： 483 consecutive nondiabetic and non-obese patients who underwent coronary angiography for the evaluation of CAD were recruited from March 2013 to March 2014. The patients were divided into insulin resistant （ HOMA-IR ≥2. 84, n = 118 ） and insulin sensitivity （ IS, HOMA-IR 〈 2. 84, n = 365 ） according to the homeostasis model assessment insulin resistance index（ HOMA-IR）. The number of diseased coronary artery and angiographic characteristics of coronary atherosclerosis defined by SYNTAX score were used to evaluate the extent and severity of coronary artery. Results： Compared with IS patients, the patients with IR were younger and had significantly （ P 〈 0. 05 ） higher values of BMI, TG, fasting blood glucose, fasting plasma insulin, fasting C-peptide, UA, hsCRP and HOMA IR. The percent of hypertension（72. 9% vs. 57.5% ,P =0. 03 ）, overweight （76. 3 % vs. 50. 7 % , P = 0. 00） and multi-vessel lesion （50% vs. 36. 7 % , P = 0. 01 ） were also higher than IS. After adjusting many traditional risk factors of coronary heart disease including TC, HDL- C, current smoking and hypertension, there was a significant correlation between HOMA-IR and number of dis- eased coronary arteries （ r = 0. 23, P = 0. 00） , SYNTAX score （ （ r = 0. 20, P = 0. 01 ） and number of stents （ r = 0. 17,P = 0. 02）. Logistic regression analysis show smoking （ OR = 1.86, P = 0. 02 ） and TC （ OR = 1.25, P = 0.04） are the independent risk factor of CAD. Coneluslon： IR was associated with the extent and severity of CAD as measured by both the number of diseased coronary arteries and SYNTAX score in non-diabetic and nonobese patients. Cardiologist might able to identify the high risk patients by measure of IR and it might be a new target for prevent coronary atheroselerosis.