正常糖耐量患者胰岛素抵抗与冠状动脉病变的相关性分析  

Correlation between insulin resistance and coronary artery disease in patients with normal glucose tolerance

作　　者：叶子青[1] 乔松[2] 俞志红[3] 叶莉[3] 金海燕[3] 

机构地区：[1]浙江医院内分泌科,杭州310013 [2]浙江医院ICU,杭州310013 [3]浙江医院干部保健科,杭州310013

出　　处：《解放军医学杂志》2011年第9期945-947,共3页Medical Journal of Chinese People's Liberation Army

基　　金：浙江省医药卫生科技计划(2011KYB21)

摘　　要：目的探讨正常糖耐量患者胰岛素抵抗(IR)与冠状动脉病变的相关性。方法纳入浙江医院2007年1月-2010年12月收治的正常糖耐量患者129例,根据新HOMA稳态模型按胰岛素敏感指数(ISI)分为胰岛素敏感(IS)组(n=68)和IR组(n=61),分别测定两组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、同型半胱氨酸(HCY)、血尿酸(UA)水平,并进行选择性冠状动脉造影及Gensini评分,采用Spearman、偏相关和多元逐步回归对结果进行相关性分析。结果与IS组比较,IR组冠状动脉病变程度严重,0支病变(29.8%vs11.8%,P<0.05)和1支病变(26.3%vs11.8%,P<0.05)比例显著降低,而多支病变比例(14.1%vs49.0%,P<0.01)、Gensini评分(10.6±12.7vs32.2±34.3,P<0.01)显著增高。校正影响因素后,Gensini评分与ISI呈明显的负相关(r=-0.354,P<0.01);多元逐步线性回归分析显示,ISI、HCY是影响Gensini评分的独立因素。结论在正常糖耐量患者中,IR与冠状动脉病变显著相关,是其独立的危险因子。Objective To investigate the correlation between insulin resistance（IR） and coronary artery disease in patients with normal glucose tolerance.Methods One hundred and twenty-nine patients with normal glucose tolerance,who visited Zhejiang Hospital from January 2007 to December 2010,were enrolled in the present study and were divided into two groups according to homeostatic model assessment（HOMA） of insulin sensitivity index（ISI）： insulin sensitive group（IS,n=68） and IR group（n=61）.The total cholesterol（TC）,triglyceride（TG）,low-density lipoprotein cholesterol（LDL-C）,high-density lipoprotein cholesterol（HDL-C）,homocysteine（HCY）,and uric acid（UA） were measured for each patient using an auto biochemistry analyzer.Selective coronary angiography and Gensini score were performed on all the patients.Spearman＇s correlations and stepwise multiple regression analysis were used in the data analysis.Results The coronary artery lesions were more severe in the IR group than in the IS group.The percentages of normal and one-vessel disease were significantly lower in the IR group（both 11.8%） than in the IS group（29.8% and 26.3%,respectively,P0.05）.The percentage of multi-vessel disease and Gensini score were significantly higher in the IR group（49.0% and 32.2±34.3,respectively） than in the IS group（14.1% and 10.6±12.7,respectively,P0.01）.A negative correlation was identified through partial correlation analysis between the Gensini score and ISI（r=-0.354,P0.01） after adjusting for influential factors.Stepwise multiple linear regression analysis indicated that ISI and HCY are the independent factors for the Gensini score.Conclusion Insulin resistance is closely correlated with the severity of coronary artery lesions,and is an independent risk factor for coronary artery disease in patients with normal glucose tolerance.

关 键 词：胰岛素抗药性 冠状动脉疾病 正常糖耐量 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]