急性心肌梗死非糖尿病患者冠状动脉粥样硬化与胰岛素抵抗的相关性研究

Insulin resistance is associated with coronary atherosclerosis in non-diabetic patients with acute myocardial infarction

目的 研究非糖尿病患者中,胰岛素抵抗是否和冠状动脉粥样硬化形成具有独立的相关性。方法 该试验入选2008年~2014年通过冠状动脉造影明确诊断为急性心肌梗死非糖尿病患者,测定胰岛素抵抗,根据稳态模型评估胰岛素抵抗指数将研究对象四分位法分为1、2、3和4组,分析患者人口统计学、临床特征和低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、甘油三酯（TG）、糖化血红蛋白和超敏C反应蛋白（hs-CRP）等新陈代谢因子,基于Poisson回归模型,判断评估非糖尿病患者胰岛素抵抗与冠状动脉粥样硬化的相关性。结果 入院研究对象共1 073例,平均年龄为56岁,女性占28.9%,4组患者多支血管病变发生率分别为37.8%、42.3%、47.2%和48.0%（P=0.009）。多变量分析中,同四分位1组相比,四分位3组[RR（95%CI）=1.31（1.07~1.60）]和4组[RR（95%CI）=1.29（1.03~1.60）]与多支血管病变具有独立的相关性。结论 该研究表明急性心肌梗死非糖尿病患者中,胰岛素抵抗与多支血管病变具有独立的相关性。

[Objective] To assess the association between insulin resistance and clinically significant an- giographic atherosclerosis in non-diabetic patients. [Methods] The association between insulin resistance and the extent of coronary atherosclerosis determined by angiography was examined in non-diabetic patients sur- viving acute myocardial infarction （AMI） between 2008 to 2014. The patients were divided into 4 groups based on the homeostasis model assessment grading of insulin resistance （HOMA-IR）. We assessed whether insulin resistance was independently associated with clinically significant angiographic atherosclerosis in non- diabetic patients. [Results] Overall, the cohort had 1,073 people with a median age of 56 years and women accounting for 28.9%. The crude prevalence of MVD was 37.8%, 42.3%, 47.2% and 48.0% for the HOMA- IR groups 1, 2, 3 and 4 respectively （P= 0.009）. In multivariable modeling, compared with the group 1, both the groups 3 [RR （95%CI） = 1.31 （1.07-1.60）] and 4 [RR （95%CI） = 1.29 （1.03-1.60）] were independently associated with MVD. Covariates in the model included patient demographic and clinical characteristics and metabolic factors （LDL-C, HDL-C, triglyeeride, HbAlc and hs-CRP）. [Conclusion] There is an independent association between insulin resistance and MVD in non-diabetic post-AMI patients.