急性冠脉综合征患者胰岛素抗性与血管内皮功能的相关性研究

The relationship between insulin resistance and endothelial function of acute coronary syndrome

目的探讨急性冠脉综合征(ACS)患者胰岛素抗性与血压、血脂、超敏C反应蛋白(hs-CRP)及肱动脉舒张功能的相关性;观察比格列酮短期治疗对ACS合并胰岛素抵抗(IR)患者胰岛素抗性及肱动脉血管舒张功能的改善作用。方法选取住院ACS患者60例,监测空腹血糖(FBG)及空腹胰岛素(FINS)水平,应用HOMA-IR方法计算IR水平,以HOMA-IR≥2.69为存在IR的标准。随机给予IR组患者比格列酮30 mg/d治疗2周,根据HOMA-IR水平及是否应用比格列酮改善IR治疗,将其分为非IR对照组20例、IR未干预组20例及比格列酮治疗组20例,观察收集患者病史、体重指数(BMI),测定其基线血压、心率、白细胞计数(WBC)、红细胞沉降率(ESR)、血脂、超敏C反应蛋白(hs-CRP)、尿酸(UA)及肝肾功能,行冠脉造影检查明确冠状动脉病变情况,应用超声心动图测定患者肱动脉内径、反应性充血后内皮依赖性血管舒张(FMD)及含服硝酸甘油后的非内皮依赖性血管舒张(NID)功能。所有入选者于2周后复查血脂、肝肾功能、hs-CRP、FBG、FINS、HOMA-IR及FMD、NID水平。结果 IR组及比格列酮治疗组FBG及FINS均值均较对照组均明显升高(P<0.001),ACS合并IR的患者其FMD水平较单纯ACS患者明显降低(P=0.005),2周后比格列酮组FINS及Ln(HOMA-IR)水平较基线明显降低(P<0.001),FMD水平与基线比较明显改善。结论 ACS合并IR患者其DBP较单纯ACS患者明显升高,FMD水平明显降低,而SBP、肝肾功能、血脂、hs-CRP、冠脉造影结果及NID水平无明显差异。短期比格列酮治疗能够显著降低FINS及HOMA-IR水平,并可能改善FMD水平。

Objective To investigate the influence of insulin resistance to forearm artery′s dilation of acute coronary artery patients,and the role of short time rosiglitazone therapy to insulin resistance and forarm artery′s dilation. Methods 60 patients with acute coronary syndrome （ACS）were selected. Fasting glucose and fasting insulin were assayed by routine laboratory techniques. The marker of insulin resistance（IR）, the homeostasis model assessment（HOMA）index,was defined as fasting plasma insulin（μU/ ml）× fasting glucose（mmol/ L）/ 22. 5. IR was defined as HOMA - IR≥2. 69,then given the people with IR rosiglitazone 30 mg/ d randomly. Therefore,the participants were divided into 3 groups：control team,patients of ACS without IR;patients of ACS with IR,but didn′t treat with rosiglitazone;patients of ACS with IR patient were treated with rosiglitazone. The patients′ history and VMI were recorded. The blood pressure,lipids,high - sensitivity C - reactive protein（hs -CRP）,white blood cell count（WVC）,uric acid,etc,brachial artery′s diameter,flow - mediated dilation（FMD）and nitroglycerin - induced dilation（NID）were measured by echocardiogram. All of these indexes were measured at baseline and 2 weeks after observation,then compared these index of three groups. Results The index of IR team and rosiglitazone team were higher than control team（ P 〈 0. 001）. FMD of ACS with IR was significantly damaged than ACS without IR（ P = 0. 005）. After 2 weeks observation,FINS and Ln（HOMA - IR）of rosiglitazone team was decreased significantly compared with baseline（ P 〈 0. 001）. FMD% was improved significantly（ P 〈 0. 001）. Conclusion The DVP was higher and FMD% was more impaired in ACS with IR than only ACS. Short time rosiglitazone therapy can decrease FINS and HOMA - IR,it maybe can improve the FMD% of brachial artery.