血清瘦素及胰岛素抵抗与冠脉慢血流的相关性及其临床意义

The clinical significance and correlation between serum leptin levels,insulin resistance and coronary slow flow

目的分析血清瘦素水平及胰岛素抵抗(IR)与冠脉慢血流(CSF)的相关性及其临床意义。方法入院行冠状动脉造影(CAG)检查,其冠状动脉狭窄程度<50%的患者110例,按是否存在CSF,分为2组:慢血流组(n=48)和正常血流组(对照组,n=62)。记录慢血流患者的各主支血管校正的TIMI血流帧幅(CTFC),采用ELISA测定各组患者的血清瘦素(leptin)浓度。采用HOMA模型计数各组患者的胰岛素抵抗指数(HOMA-IR)。进行单因素和多因素分析其相关性,并采用ROC曲线评价血清瘦素水平、HOMA-IR对CSF的诊断价值。结果单因素分析中发现瘦素水平、HOMA-IR、年龄、性别、吸烟和血脂等10个指标与CSF有关,多因素分析,只有瘦素和HOMA-IR是CSF的独立相关因素(均P<0.01),血清瘦素水平与Mean TFC(r=0.816,P<0.01)呈正相关;HOMA-IR与mean TFC(r=0.622,P<0.01)呈正相关;血清瘦素水平与HOMA-IR(r=0.484,P<0.01)呈正相关。CSF患者的血清瘦素水平、HOMA-IR的ROC曲线分析,结果显示,瘦素,IR对CSF的诊断曲线下面积有统计学意义(均P<0.01),曲线下面积分别为0.972,0.836。结论血清瘦素和IR与CSF有相关性,对CSF有一定的诊断价值。

AIM To explore the clinical significance and correlation between serum leptin levels, insulin resistance, and coronary slow flow. METHODS 110 patients with coronary stenosis 〈50% according to coronary angiography （CAG） were included. They were divided into two groups： CSFP group （n=48） and NCF group （n=62）. Coronary artery TIMI frame count of the left anterior descending branch （LAD）, the left circumflex branch （LCX）, and right coronary artery （RCA） in the CSFP group and NCF group were recorded. The level of fasting serum leptin was examined by enzyme linked immunosorbent assay （ELISA）. The insulin resistance index （HOMA-IR） was calculated according to HOMA model （HOMA-IR=FBG×FINS/22.5）. The correlation between serum leptin levels, insulin resistance, and coronary slow flow was analyzed. The diagnostic value of serum leptin and HOMA-IR on CSFP was evaluated by receiver operating characteristic （ROC） curve. RESULTS Single factor analysis demonstrated that leptin levels, HOMA-IR, age, gender, smoking and blood lipids, and 4 other indicators were related to CSF. Multivariate analysis revealed that only leptin and HOMA-IR were independent factors associated with CSF. Serum leptin levels were positively correlated with mean TFC （r=0.816, P〈0.01）; HOMA-IR was positively correlated with mean TFC （r=0.622, P〈0.01）. Serum leptin levels weree positively correlated with HOMA-IR （r=0.484, P〈0.01）. The serum leptin level and HOMA-IR ROC curves of CSF patients were analyzed. The results showed that the area under the diagnostic curve of leptin and IR to CSF was statistically significant （P〈0.01） and the area under the curve was 0.972, 0.836. CONCLUSION Serum leptin levels and insulin resistance are associated with CSFP, which have certain diagnostic value for CSF.