非糖尿病、非肥胖、非ST段抬高急性冠状动脉综合征患者平均血小板体积与胰岛素抵抗的相关性分析

目的:观察无糖尿病、不肥胖的非ST段抬高急性冠状动脉综合征患者,平均血小板体积(mean platelet volume,MPV)与胰岛素抵抗的相关性和临床的意义。方法:连续入选236例非糖尿病、非肥胖、非ST段抬高急性冠状动脉综合征患者,测定外周血液学指标以及其他生化指标。根据稳态模型胰岛素抵抗指数(homeostasis model assessment insulin resistance index,HOMA-IR)分为胰岛素抵抗组90例和胰岛素敏感组146例。比较两组患者临床和血液学参数。结果:胰岛素抵抗患者男性(P=0.003)、高血压(P=0.004)、超质量(P0.001)比例高;服用β-受体阻滞剂(P=0.003)和硝酸脂类药物(P=0.001)比例高。胰岛素抵抗组患者TG、UA、高敏C-反应蛋白、空腹血糖、空腹胰岛素、C-肽、HOMA-IR、BMI、MPV、血小板分布宽度、大血小板比例、红细胞计数和血红蛋白含量,也较胰岛素敏感组患者明显增高(P0.05),HDL-C明显降低(P=0.03)。相关分析显示,MPV分别与HOMA-IR(r=0.35,P0.001)、空腹胰岛素(r=0.37,P0.001)、C-肽(r=0.27,P0.001)、血小板分布宽度(r=0.53,P0.001)、大血小板比例(r=0.74,P0.001)以及BMI(r=0.17,P=0.009)呈正相关,与血小板计数呈负相关(r=-0.46,P0.001)。结论:对于非糖尿病、非肥胖、非ST段抬高急性冠状动脉综合征患者,MPV在胰岛素抵抗组明显增加且与HOMA-IR呈显著正相关,胰岛素抵抗的非ST段抬高急性冠状动脉综合征患者血小板激活程度较高,应该采取更积极的抗血小板策略。

The analysis of correlation of mean platelet volume and insulin resistance in non-obese,non-diabetic,non-ST-segment elevated acute coronary syndromes

Objective：Mean platelet volume （MPV） is an important biological variable and an indicator of platelet activation.Elevated MPV has been proposed as a risk factor for coronary artery disease and is associated with poor clinical outcome in acute coronary syndrome （ACS）.Insulin resistance is established to be one of the risk factors for coronary artery disease.Many studies showed that insulin resistance had same risk factors spectrum with elevated MPV,but only few studies have investigated the direct relationship between insulin resistance and MPV.This study to assess the relationship between MPV and insulin resistance in non-diabetic,non-obese,non-ST-segment elevated ACS.Methods：Two hundred and thirty-six consecutive non-diabetic,non-obese,non-ST-segment elevated ACS patients were divided into insulin resistant and insulin sensitive according to the homeostasis model assessment insulin resistance index （HOMA-IR）.Baseline clinical details and the values of routine biochemical and hematologic parameters were compared between two groups.Results：The insulin resistant group was composed of 90 patients with mean age （59.91 ± 8.95） years and the insulin sensitive group was composed of 146 patients with mean age （60.45 ± 9.28） years.Insulin resistant patients were more likely to be males （P =0.003）,more prescribed with β-blocker （P =0.003） and nitrates （P =0.001） and had significantly higher proportion of hypertension （P =0.004） and overweight （P ＜ 0.001）.Patients with insulin resistance had significantly higher HOMA-IR scores,insulin level,and C-peptic （all P ＜ 0.001）.The values of TG,UA,high sensitive C-reactive protein,fasting glucose and body mass index （BMI）were also significantly higher in insulin resistant patients （P ＜ 0.05）.The MPV values,platelet distribution width （PDW） and platelet-large cell ratio were significantly higher in insulin resistant patients than in insulin sensitive patients [（11.1 ± 1.2） vs.（10.4 ± 1.1） fl,P ＜ 0.001 ; （13.5 ± 2.13） vs.（12.5 ± 1.7）,P ＜0.001 ; （31.2 ± 7.3） ％ vs.（28.9 ± 6.4） ％,P =0.01,respectively].The MPV was significantly positively correlated to HOMA-IR （r =0.30,P =0.054）,insulin （r =0.22,P =0.053）,C-peptic （r =0.27,P ＜ 0.001） and BMI （r =0.17,P =0.009） and was significantly inversely correlated to platelet count（r =-0.46,P ＜ 0.001）.Conclusion：MPV was significantly elevated in insulin resistant non-obese,non-diabetic,non-ST-segment elevated ACS and significantly positively correlated to HOMA-IR.The aggressive antiplatelet strategies should be taken to reduce platelet activation for insulin resistant patients with ACS.