胰岛素敏感性的改善对胰岛素抵抗患者择期冠状动脉介入治疗术后心血管事件的影响

The impact of improved insulin sensitivity on cardiovascular events in non-diabetic and insulin resistance patients undergoing elective percutaneous coronary intervention

目的：探讨胰岛素敏感性的改善对非糖尿病、非肥胖患者,择期经皮冠状动脉介入治疗术（PCI）后心血管事件的影响。方法：连续入选2013年1月至2014年1月间,因心绞痛住院并接受择期PCI治疗的非糖尿病、非肥胖胰岛素抵抗（HOMA-IR≥2.92）患者147例。所有患者术后接受规范的药物治疗和生活方式指导。根据术后6个月HOMA-IR结果将患者分为IR改善组（n=45）和IR持续组（n=102）。随访1年,观察两组患者主要心血管事件（死亡、非致死性心肌梗死、再次血运重建及支架血栓）的发生率。结果：与IR持续的患者相比,IR改善的患者靶血管（12.7%vs.2.2%,P=0.05）和靶病变（11.8%vs.2.2%,P=0.06）血运重建的发生率低;心血管事件的发生率（22.5%vs.13.3%,P=0.20）差异无统计学意义。多因素Cox比例危险度模型分析显示,持续吸烟是PCI术后心血管事件的独立预测因素（HR=7.68,95%CI：3.63-16.22,P〈0.00）。结论：短期胰岛素敏感性的改善对PCI术后心血管事件无显著影响,持续吸烟是预测PCI术后心血管事件的独立危险因素。

Objective：Insulin resistance （IR） is a predictor of cardiovascular （CV） events even before the onset of diabetes. However, it is unclear whether improved the insulin sensitivity may affect long-term outcome in patients undergoing pereutaneous coronary intervention （PCI）. Methods： The study enrolled 147 non- diabetic patients with newly diagnosed CAD and IR. All patients received optimized therapy including medica- tions and lifestyle changes. Evaluation of IR was repeated at 6 months after PCI. All patients were prospectively followed-up for one year or until the occurrence of one of the following events： death, nonfatal myocardial infarction, coronary revascularization and in-stent thrombosis. Results ： IR was improved in 45 （ 30. 6% ） patients. During the follow-up, target vessel revascularization （ 12. 7% vs. 2. 2% , P =0. 05） and target lesion revascularization （ 11.8% vs. 2. 2%, P =0. 06） were lower in patient with improved IR status, but the incidence of major cardiovascular events was no significant difference between two groups （ 22. 5% vs. 13.3% , P = 0. 20）. Multivariate Cox proportional hazards analysis identified that persistent smoking but not persistent IR was an independent predictor of future CV events （HR = 7. 68, 95% CI 3.63-16. 22, P 〈 0. 00）. Conclusion： Improved IR sensitivity was not associated with the decreased CV events after PCI. The persistent smoking was an independent risk factor for CV events after PCI.