胰岛素对2型糖尿病合并冠心病患者心肌微循环的影响

Influence of insulin on myocardial microcirculation in patients with type 2 diabetes mellitus complicated coronary heart disease

目的:通过比较冠心病合并2型糖尿病患者冠脉介入治疗(PCI)术后选择胰岛素还是口服降糖药治疗来研究胰岛素对微循环的影响。方法:入组65例冠脉造影明确冠心病且经压力导丝测定心肌血流储备分数(FFR)<0.75的患者,植入药物支架后测量微循环阻力指数(IMR),按目前是否应用胰岛素分为联合胰岛素治疗组(胰岛素组,30例)和单纯口服降糖药治疗组(单纯降糖药组,35例),随访半年,复查IMR,比较二者对心肌微循环的影响。结果:两组的主要心血管不良事件(MACEs)发生率无明显统计学差异(P=0.07)。胰岛素组术后半年的IMR水平较单纯降糖药组显著降低[(24.5±3.1)U比(30.2±4.3)U,P<0.05]。结论:冠心病合并2型糖尿病患者介入治疗术后胰岛素治疗能显著改善心肌微循环。

Objective： To study influence of insulin on myocardial microcirculation of patients with coronary heart disease （CHD） complicated type 2 diabetes mellitus （T2DM） after percutaneous coronary intervention （PCI）. Meth- ods.. A total of 65 patients, who was confirmed as CHD by coronary angiography and fractional flow reserve （FFR） d0.75 measured by pressure guidewire, were enrolled. After drug-eluting stent implantation, index of microcireula- tion resistance （IMR） was measured. According to insulin usage or not, they were divided into insulin therapy group （insulin group, n = 30） and pure oral hypoglycemic agent therapy group （pure hypoglycemic agent group, n = 35）. After six-month follow up, IMR was reviewed, and IMP, was compared between two groups. Results： There was no significant difference in incidence rate of major adverse cardiovascular events （MACEs） between two groups, P= 0. 07. On six months after PCI, IMR in insulin group was significantly lower than that of pure hypoglycemic agent group [ （24.5± 3.1） U vs. （30.2± 4. 3） U, P〈O. 05]. Conclusion： Insulin therapy can improve myocardial microcirculation in patients with coronary heart disease complicated type 2 diabetes mellitus after PCI.