心理应激对冠心病合并2型糖尿病患者PCI术后糖代谢、胰岛素抵抗及炎症介质水平的影响  

Effects of psychological stress on glucose metabolism,insulin resistance and inflammatory mediators in patients with coronary heart disease and type 2 diabetes mellitus after PCI surgery

作　　者：李玉 段敬柱[1] LI Yu;DUAN Jingzhu(Internal Medicine -Cardiovascular Department,Taihe Hospital of Shiyan City,Shiyan 442000,China)

机构地区：[1]湖北省十堰市太和医院心血管内科

出　　处：《中国健康心理学杂志》2019年第1期89-92,共4页China Journal of Health Psychology

摘　　要：目的:探究心理应激对冠心病合并2型糖尿病(T2DM)患者经皮冠状动脉介入治疗(PCI)术后糖代谢、胰岛素抵抗及炎症介质水平的影响。方法:选取2015年7月-2017年7月于我院行PCI手术治疗的120例冠心病合并T2DM患者,使用症状自评量表(SCL-90)将其分为高分组(SCL-90评分≥全国常模标准160分,n=52)与低分组(SCL-90评分<全国常模标准160分,n=68)。比较两组糖代谢指标[空腹血糖(FBG)、餐后2h血糖(2hFBG)、糖化血红蛋白(HbA1c)]、胰岛素抵抗指标[空腹胰岛素(FINS)、胰岛素敏感指数(ISI)、胰岛素抵抗指数(HOMA-IR)]及炎症介质水平[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及超敏C-反应蛋白(hs-CRP)],并采用Pearson相关分析SCL-90评分与各指标间的相关性。结果:高分组术后FBG、2hPBG、HbAlc、FINS、HOMA-IR及IL-6、TNF-α、hs-CRP水平均显著高于低分组,ISI水平显著低于低分组,差异均具有统计学意义(t=5.077,2.939,4.918,3.589,6.435,5.996,6.074,4.223,-5.696;P<0.05);Pearson相关性分析结果显示,冠心病合并T2DM患者SCL-90评分与FBG、2hPBG、HbAlc、FINS、ISI、HOMA-IR、IL-6、TNF-α、hs-CRP水平显著正相关(r=0.401,0.312,0.369,0.334,0.423,0.438,0.429,0.432,0.345;P<0.05)。结论:心理应激程度与冠心病合并T2DM患者PCI术后糖代谢异常、胰岛素抵抗作用、机体炎症反应等病情恢复情况密切相关,应引起临床重视,在围手术期及时干预。Objective:To explore the effects of psychological stress on glucose metabolism,insulin resistance and inflammatory mediators in patients with coronary heart disease complicated with type 2 diabetes mellitus(T2DM)after percutaneous coronary intervention(PCI)surgery.Methods:A total of 120 cases of patients with coronary heart disease and T2DM treated with PCI in our hospital from July 2016 to July 2017 were selected and divided into the high-score group(SCL-90 score≥national norm standard 160 points,n=52)and the low-score group(SCL-90 score<national norm standard 160 points,n=68)according to the symptom check list(SCL-90).The glucose metabolism indexes[fasting blood glucose(FBG),2 hpostprandial blood glucose(2 hFBG),glycosylated hemoglobin(HbA1 c)],the insulin resistance indexes[fasting insulin(FINS),insulin sensitivity index(ISI)and insulin resistance index(HOMA-IR)]and the inflammatory mediators levels[interleukin-6(IL-6),tumor necrosis factorα(TNF-α)and high sensitivity C-reactive protein(hs-CRP)]were compared between two groups,and the Pearson correlation analysis was used to analyze the correlation between the SCL-90 score and each indicator.Results:The postoperative levels of FBG,2 hPBG,HbA1 c,FINS,ISI,HOMA-IR and IL-6,TNF-αand hs-CRP in the high-score group were significantly higher than those in the low-score group,the level of ISI was significantly lower than that of the lower group(t=5.077,2.939,4.918,3.589,6.435,5.999,6.074,4.223,-5.696;P<0.05).Pearson correlation analysis showed that there were significantly positive correlation between the SCL-90 score and the levels of FBG,2 hPBG,HbAlc,FINS,ISI,HOMA-IR,IL-6,TNF-αand hs-CRP in the CHD patients with T2 DM(r=0.401,0.312,0.369,0.334,0.423,0.438,0.429,0.432,0.345;P<0.05).Conclusion:The degree of psychological stress is closely related to the abnormal glucose metabolism,insulin resistance,the body’s inflammatory response and other recovery conditions in patients with coronary heart disease and T2DM after PCI surgery,therefore it should cause clinica

关 键 词：心理应激 冠心病 2型糖尿病 糖代谢 胰岛素抵抗 炎症介质 

分 类 号：R749.92[医药卫生—神经病学与精神病学]