代谢综合征合并冠心病的老年患者血清总同型半胱氨酸水平与胰岛素敏感性的关系

Relationship between insulin sensitivity and serum total homocysteine in aged patients with metabolic syndrome accompanied by coronary atherosclerotic heart disease

目的 探讨代谢综合征 (MS)及合并冠心病 (CHD)的老年患者空腹血清总同型半胱氨酸 (totalhomocysteine ,tHcy)水平和胰岛素敏感性及与MS其他成分的相互关系。方法 用化学免疫发光法测定单纯MS组 ( 34例 )、MS合并CHD组 ( 30例 )和正常对照组 ( 16例 )空腹血清tHcy水平 ,并收集MS的其他有关数据 :体重指数、空腹血糖、空腹血浆胰岛素、糖化血红蛋白 (HbA1c)和血脂 ,计算胰岛素敏感指数 (ISI)。结果 tHcy在正常对照组 ( 10 .9± 3.8)μmol L,MS组 ( 14 .3± 4 .2 ) μmol L ,MS +CHD组 ( 19.2± 2 .9) μmol L ,3组间差异有显著性意义 ;空腹血清tHcy水平与ISI呈负相关 ( r =- 0 .2 2 1,P<0 .0 5 ) ;与体重指数 ( r =0 .12 5 ,P<0 .0 5 )、空腹血糖 ( r =0 .2 18,P<0 .0 5 )和HbA1c(r=0 .312 ,P <0 .0 5 )呈正相关 ;以空腹血清tHcy水平为应变量的logistic多元逐步回归分析提示 ,ISI(r2 =0 .2 3)、HbA1c( r2 =0 .2 1)和血清甘油三酯水平 ( r2 =0 .15 )与tHcy具有相关性 ( P <0 .0 5 )。结论 MS患者tHcy水平增加 ,合并CHD的MS患者更为明显 ,并与胰岛素敏感性下降相关 ,可能在MS发展为CHD中起一定作用。

Objective To examine the fasting serum total homocysteine (tHcy) levels in aged subjects with metabolic syndrome (MS) or MS accompanied by coronary atherosclerotic heart disease (MS+CHD), and to investigate the relationship between tHcy levels and features of MS.Methods Fasting serum tHcy levels were measured in 34 MS patients, 30 MS+CHD patients and 16 healthy controls by means of immunochemiluminometric assay method. The information on conventional clinical features of MS was collected.Results (1) Univariate analysis revealed significant difference in tHcy concentrations between controls [(10.9±3.8) μmol/L], and subjects with MS [(14.3±4.2) μmol/L], or subjects with MS+CHD [(19.2±2.9) μmol/L];(2) Correlation analysis results suggested that the serum tHcy concentration was related to insulin sensitivity index (ISI) (r=-0.221, P<0.05), or to components of the MS, including body mass index (BMI) (r=0.125, P<0.05), fasting blood sugar (FBS) (r=0.218, P<0.05), or HbA1c (r=0.312 , P<0.05);(3)Logistic regression analysis indicated a statistically significant relationship between tHcy concentration and ISI (r 2=0.23, P<0.05)、HbA1c(r 2=0.21, P<0.05) or TG (r 2=0.15, P< 0.05 ).Conclusion These findings strengthen the possibility that disturbed homocysteine metabolism is related to the decrease in insulin sensitivity, and may contribute to development to coronary atherosclerotic heart disease from metabolic syndrome.