胰岛素抵抗指数对急性冠状动脉综合征患者预后的预测价值  

Value of insulin resistance index in predicting outcomes of patients with acute coronary syndrome

作　　者：赵宇[1] 郑坚奕[1] 曾智桓[1] 朱桂平[1] 周嘉辉[2] 林展翼[2] 

机构地区：[1]广东药学院附属第一医院心内科,广州510086 [2]广东省心血管病研究所广东省人民医院(广东省医学科学院),广州510010

出　　处：《岭南心血管病杂志》2016年第5期526-528,553,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探索胰岛素抵抗指数对急性冠状动脉综合征患者预后的预测价值。方法收集2010年11月至2011年7月经冠状动脉造影确诊为冠状动脉粥样硬化性心脏病(冠心病)、临床诊断为急性冠状动脉综合征的患者358例。根据患者空腹血糖及空腹胰岛素浓度计算出稳态模型的胰岛素抵抗指数(homeostasis model assessment insulin resistance index,HOMA2-IR)后分为两组:胰岛素抵抗组(HOMA2-IR>2.8,n=128);胰岛素敏感组(HOMA2-IR≤2.8,n=230)。比较两组间血白细胞、纤维蛋白原(fibrinogen,FIB)及血清超敏C反应蛋白(high-sensitivity C-r eactive protein,hs-CRP)、尿酸(UA)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(Hb A1c)浓度,并比较两组间冠状动脉病变严重程度。随访24个月,观察两组间主要不良心血管事件发生情况的差别。结果胰岛素抵抗组的炎症指标:血白细胞计数及血清hs-CRP、FIB浓度均明显高于胰岛素敏感组,差异有统计学意义(P<0.05)。两组间冠状动脉病变严重程度比较,差异无统计学意义(P>0.05)。胰岛素抵抗组在术后再发心绞痛(P=0.015)及脑梗死发病率(P=0.038)要明显高于胰岛素敏感组;两组间再发心肌梗死,心力衰竭发病率及心源性病死率比较,差异无统计学意义(P>0.05)。结论胰岛素抵抗指数升高患者体内的炎症水平更高,术后有更高的再发心绞痛、脑梗死发生率。Objectives To investigate the value of insulin resistance index in predicting outcomes of patients with acute coronary syndrome. Methods From November 2010 to July 2011, 358 cases clinically diagnozed of acute coronary syndrome and coronary artery disease by coronary angiography were collected. Homeostasis model assessment insulin resistance index （HOMA2-IR） was calculated according to the fasting blood glucose and fasting insulin concentrations. All the cases were divided into two groups： insulin resistant group （HOMA2-IR〉 2.8, n=128） and insulin sensitive group （HOMA2-IR ≤ 2.8, n =230） according to the HOMA2-IR value. White blood cell count, fibrinogen （FIB） and serum concentrations of high-sensitivity C-reactive protein （hs-CRP）, uric acid （UA）, triglyceride （TG）, total cholesterol （TC）, high-density lipoprotein cholesterol （HDL-C）, low-density lipoprotein cholesterol （LDL-C）, glycosylated hemoglobin （HbAlc） and severity of coronary artery disease between the two groups were compared. The cases were followed up for 24-36 months and the occurrence of major adverse cardio, Jascular events were observed. Results Insulin resistant group had significantly higher white blood cell count and serum concentrations of hs-CRP, FIB than insulin sensitive group （P〈0.05）. The severity of coronary artery disease had no significant difference between the two groups （P〉0.05）. Insulin resistant group had significantly higher incidences of postoperative recurrent angina （P= 0.015） and cerebral infarction （P=0.038） than insulin sensitive group; but incidences of recurrent myocardial infarction, heart failure, and cardiac death had no significant differences between the two groups （P〉0.05）. Conclusions Patients with higher insulin resistance index have higher serum concentrations of inflammation indexes, higher incidences of postoperative recurrence of angina and cerebral infarction.

关 键 词：冠状动脉疾病 胰岛素抵抗指数 冠状动脉病变严重程度 预后 

分 类 号：R541.4[医药卫生—心血管疾病]