高胰岛素血症与心血管疾病

本文综述了高胰岛素血症与心血管疾病危险因素的关系，包括高血压，高脂血症，肥胖，高尿酸血症，纤溶酶原激活抑制物１，左室肥厚，性激素，非胰岛依赖型糖尿病及糖耐量低下等。     

糖尿病与高胰岛素血症

绝大多数 T2 DM存 IR,IR是 T2 DM自然病程中的早期表现 ,此时胰岛素分泌可以正常或增加。因此认为 ,IR是T2 DM的原发性、遗传性成分 ,而环境因素如肥胖和生活方式等促进了疾病的进展。存在原发性 IR的情况下 ,如果胰岛 β细胞功能正常 ,则出现代偿性高胰岛素血症 ,并维持葡萄糖     

糖尿病并高血压患者高胰岛素血症初步探讨

对16例NIDDM合并高血压而无心、肾功能损害者与16例NIDDM血压正常者进行配对研究。同步检测空腹及馒头试验后血糖、胰岛素、C-肽等指标。NIDDM合并高血压组血清胰岛素水平、胰岛素/C-肽值明显高于NIDDM血压正常组,而胰岛素敏感指数则明显降低。结果表明,NIDDM合并高血压与高胰岛素血症有关,后者主要是由于肝脏对胰岛素清除率降低所致。     

NIDDM患者左心室功能与高胰岛素血症的关系探讨

观察９８例ＮＩＤＤＭ患者彩色多普勒超声心动图、血清胰岛素和Ｃ肽释放试验的检测结果，显示在左心室功能障碍的患者血清胰岛素水平，胰岛素／Ｃ肽比值均较左心室功能正常的患者增高，而胰岛素敏感性指数则降低，提示高胰岛素血症可能参与ＮＩＤＤＭ患者左心室功能异常的发生机制。     

不稳定性心绞痛患者的高胰岛素血症

检测冠心病不稳定性心绞痛２４例，稳定性心绞痛２９例，对照组３０例糖耐量前后血糖、胰岛素（ＩＳ）、Ｃ肽（ＣＰ）的变化。结果不稳定性心绞痛组和稳定性心绞痛组空腹和服糖后的ＩＳ、ＣＰ均明显升高，前组与后组相比，显示更高的ＩＳ、ＣＰ浓度（Ｐ〈０．０５￣０．００１）。提示冠心病的高胰岛素血症与其临床症状的严重程度相关，而高胰岛素血症对神经体液的影响可能会导致心绞痛的恶化。     

糖尿病并高血压、高胰岛素血症

对１１２例Ⅱ型糖尿病（并高血压及无高血压各５６例和２０例高血压患者测定空腹胰岛索水平，发现高血压、糖尿病并高血压的胰岛素与血清甘油三酯水平均明显高于正常值，也高于糖尿病无高血压组（Ｐ＜０．００１）。糖尿病并高血压的并发症以冠心病为多。     

Ⅱ型糖尿病高胰岛素血症与血中游离胰岛素的改变

对２３０例Ⅱ型糖尿病病人进行了分析，结果表明：有高胰岛素血症的其血糖、血压、血脂水平均高于胰岛素水平正常者（Ｐ〈０．０５）。对其中４２例测血游离胰岛素发现：这些病人的游离胰岛素水平并不高或降低，表现为活性胰岛素的缺乏或相对性缺乏。这可能有助于说明在高胰岛素情况下，胰岛素的作用并不相应增加。     

糖尿病患者急性心肌梗塞的治疗

糖尿病是心血管疾病的一个重要独立危险因子,由于易患冠心病,糖尿病患者的预期寿命大约仅为同龄人的三分之二。与一般人群相比,糖尿病患者发生急性心肌梗塞预后更差,住院死亡率约增加2倍。近年认为,糖尿病患者发生急性心肌梗塞后,除了用与一般人群一样的综合治疗措施外,还应该采用一些特殊的治疗方案,包括用强化胰岛素治疗使血糖达到理想控制、血栓溶解疗法、早期使用β阻滞剂和血管紧张素转换酶抑制剂(ACEI)等[1～3],本文对此作一综述。一、严格控制血糖血糖控制对减少糖尿病患者发生大血管病变的作用尚不完全清楚,一些研究表明,急性心肌…     

高胰岛素血症:因还是果?

2011年美国糖尿病协会(ADA)年会Banting科学成就奖获得者为波士顿大学的Barbara E.Corkey.她提出2型糖尿病的先决原因是高胰岛素血症,而胰岛素抵抗是其后的代偿.基础胰岛素分泌过剩的原因在于环境因素.其提出2型糖尿病的发病模型是:环境因素造成了高基础胰岛素血症.而环境因素导致胰岛素分泌过剩的共同路径是氧化还原反应的紊乱.     

Prognosis of Acute Myocardial Infarction in Diabetic and Non-diabetic Patients

We evaluated the prognosis of 858 patients with acute myocardial infarction (MI), of whom 97 (11%) had a history of diabetes mellitus. Among patients with diabetes the 1-year mortality rate was 41% versus 26% for non-diabetic patients (p < 0.01), and the 1-year reinfarction rates were 23% and 14%, respectively (p = 0.05). Diabetic patients with a history of hypertension had a similar mortality rate as comapred with diabetic patients without hypertension. In a multivariate analysis including age and history of cardiovascular disease, diabetes did not significantly contribute to death or reinfarction. Among diabetic patients the only independent risk factor for death was age. The place and mode of death appeared similar in the two groups. Patients with and without a history of diabetes had a similar infarct size. We conclude that diabetic patients with acute myocardial infarction have a very poor prognosis. Within 1 year nearly half of them are dead and one-quarter develop reinfarction. The mode of death appeared to be similar in diabetic patients as compared with non-diabetic patients.     

急性心肌梗死患者中几种炎症因子与传统心肌损伤标志物的相关性研究

目的选取多个炎症因子—基质金属蛋白酶抑制剂1(TIMP1),基质金属蛋白酶9(MMP9),新蝶呤(Neopterin),观察其在急性心肌梗死(AMI),不稳定性心绞痛、稳定性心绞痛和正常人群中的不同表达水平以及与传统心肌损伤标志物之间的相互关系,以期探索其在AMI发病进展过程中的作用和用于预测急性心梗风险的可行性。方法从收住本院的患者中,入选AMI51例,不稳定性心绞痛48例,稳定性心绞痛54例,正常人44例。所有患者的确诊依据世界卫生组织诊断标准和中华医学会的相关指南。所有患者均接受冠脉造影检查,同时采集血标本。用ELISA法分别测定4组患者的MMP9,TIMP1和Neopterin浓度。所得数据使用SPSS统计软件处理,以P0.05作为有统计学意义的显著性差异。各个数据之间的相关采用单回归线性分析检验。结果 (1)基本临床资料:四组之间在年龄和高血脂,糖尿病发病率上无显著性差异,正常组男性,高血压和吸烟史相对其他组较少。稳定心绞痛和不稳定心绞痛高血压的发生率高于急性心梗。(2)传统的心肌损伤标志物和炎症因子检测结果:高敏C反应蛋白,肌酸激酶,肌酸激酶同工酶和肌钙蛋白I,急性心梗组皆高于其他3个组,有显著性差异。而其他三组之间并无显著性差异。(3)其他炎症因子检测结果:,MMP9、TIMP1、MMP9/TIMP1以及Neopterin各个指标,AMI组皆高于其他3组,有显著性差异。其他三个组相互之间并无显著性差异。(4)入选病人的Hs-CRP与Neopterin和CK呈良好的正相关性(P0.05),而MMP9/TIMP1与hs-CRP及CK皆无相关性。Neopterin与CK也无相关性。结论在AMI患者,炎症因子MMP9、TIMP1、Neopterin均明显升高,除Neopterin与Hs-CRP有良好相关性以外,其他的炎症因子与传统的心肌损伤标志物并无相关性。     

急性心肌梗死溶栓疗法临床分析

目的 分析溶栓疗法治疗急性心肌梗死的疗效.方法 选择发病在12h内的急性心肌梗死患者30例,在对症治疗的同时立即给予静脉滴注尿激酶100万U,分析患者的冠状动脉再通率情况.结果 30例患者中26例再通,再通率为86.67%,没有发生严重的不良反应.结论 心肌梗死后早期采用静滴尿激酶进行溶栓安全、有效,值得临床推广应用.     

Patient Delay in Patients With ST-elevation Acute Myocardial Infarction

Objectives To examine patient delay (PD) in seeking treatment among patients with ST-elevation myocardial infarction (STEMI) and to identify factors influencing PD. Methods patients with STEMI were divided into two groups based on PD: Short PD group (PD ≤ 60 minutes after onset of symptoms) and long PD group ( > 60 minutes after symptom onset). A questionnaire developed to assess demographic characteristics, clinical factors and psychological factors. Patients were interviewed within 72 hours of admission to 2 hospitals. Results 329 consecutive confirmed STEMI patients (Mean age 61years; 72.5% men) with a median PD of 90 min and a pre-hospital delay time 170 min were studied, PD was less than 1 hours in 47.4% of patients, while more than 1 hours in 52.6%, In univariate analyses, patients with short PD were witness onset, progress course of symptom, severe pain, death anxiety, knowing AMI as a deadly disease and its presentation, taking the symptom seriously. Patients with longer PD were age ≥65 year, nocturnal onset, experienced their symptoms at home, gradual onset, 'waited to see whether symptoms disappeared', 'worried about troubling others', 'took pain medication' and preinfarction angina. A stepwise multiple regression analysis further suggested that the following inde-pendent contributors to a late decision to seek medical help (relative risk, 95% confidence interval): taking pain medication (15.97; 1.70～149.8 ), wanting to wait and see (6.46; 1.92～21.74), not wanting to bother anybody (6.42; 2.87～14.34), preinfarct angina (2.73; 1.20～6.19), age ≥65 years (2.51; 1.15～5.48), gradual onset (2.40; 1.05～5.44), severe pain(0.38, 0.17～0.85), witness onset (0.27, 0.10～0.70), taking symptoms seriously (0.019; 0.08～0.46). Conclusions Age ≥65 years, gradual onset, witness onset, severe pain, preinfarct angina, emotional responses and coping strategies are the independent factors associated with patient delay or decision time in patients with AMI. Emotional responses and coping strategies are the major determinants of patient delay. Modification of these emotional factors might best be achieved by patients and public education.     

女性急性心肌梗塞患者溶栓疗效观察

目的　观察女性急性心肌梗塞 (AMI)患者接受静脉溶栓治疗的临床效果。方法　回顾分析 3年内接受静脉溶栓 3 0 2例 (AMI)患者中的 83例女性AMI的临床疗效。结果　 ( 1 ) 83例女性AMI与 2 1 9例男性患者比较 ,溶栓后梗塞相关血管 (IRA)再通率明显为低 ( 57 8%比 73 5% ,P <0 0 1 ) ,尤其3 8例≥ 60岁的老年女性比 92例老年男性明显为低 ( 55 9%比 73 0 % ,P <0 0 2 5)。 ( 2 )经溶栓治疗的男性AMI患者比女性的 5周死亡率 ( 4 1 %比 1 4 5% ,P <0 0 1 )及中度以上心衰率 ( 1 4 2 %比 2 6 5% ,P<0 0 5)明显为低。结论　国人女性AMI患者接受溶栓治疗安全有效 ,但其临床疗效似乎低于男性患者。     

梗死前心绞痛对合并糖尿病的急性心肌梗死患者左心室功能的影响

目的　探讨梗死前心绞痛对合并糖尿病的急性心肌梗死 (AMI)患者左心室功能的近期影响。方法　首次AMI并行急诊PCI患者 15 6例 ,在糖尿病和非糖尿病患者中分别比较有梗死前心绞痛和无梗死前心绞痛组血清肌酸激酶MB(CKMB)峰值和左心室功能的变化。结果　非糖尿病患者中有梗死前心绞痛组血清CKMB峰值低于 ,左室EF高于无梗死前心绞痛组 (CKMB :10 8± 79IU/Lvs 15 6± 10 1IU/L ;EF∶5 8± 13%vs 5 0±11% ,P <0. 0 5 ;糖尿病患者中有梗死前心绞痛组和无梗死前心绞痛组血清CKMB峰值和左心室EF无显著性差异。结论　梗死前心绞痛可在非糖尿病合并AMI患者中限制梗死面积 ,保护左心功能 ,而在糖尿病合并AMI患者中无保护作用。     

Outcomes of Acute Myocardial Infarction in Patients with Familial Hypercholesteremia

BackgroundThere is a paucity of contemporary data regarding the outcomes of acute myocardial infarction among patients with familial hypercholesteremia.MethodsWe queried the Nationwide Readmissions Database (2016-2018) for hospitalizations with acute myocardial infarction. Multivariable regression analysis was used to compare in-hospital outcomes and 30-day readmissions among patients with and without familial hypercholesteremia.ResultsThe analysis included 1,363,488 hospitalizations with acute myocardial infarction. The prevalence of familial hypercholesteremia was 0.07% among acute myocardial infarction admissions. Compared with those without familial hypercholesteremia, admissions with familial hypercholesteremia were younger and had less comorbidities but were more likely to have had prior infarct and revascularization. Admissions with familial hypercholesteremia were more likely to present with ST-elevation myocardial infarction and undergo revascularization. After multivariable adjustment, there was no difference in in-hospital case fatality among patients with hypercholesteremia compared with those without it (adjusted odds ratio [aOR] = 0.76; 95% confidence interval [CI] 0.41-1.39). Admissions with acute myocardial infarction and familial hypercholesteremia had higher adjusted rates of cardiac arrest and utilization of mechanical support. There were no group differences in overall 30-day readmission (aOR 0.75; 95% CI 0.51-1.10) or 30-day readmission for acute myocardial infarction. However, a nonsignificant trend toward higher readmission for percutaneous coronary intervention was observed among patients with familial hypercholesteremia (aOR 1.89; 95% CI 0.98-3.64).ConclusionIn this contemporary nationwide observational analysis, patients with familial hypercholesteremia represent a small proportion of the overall population with acute myocardial infarction and have a distinctive clinical profile but do not appear to have worse in-hospital case fatality compared with those without familial hypercholesteremia.     

影响急性心肌梗塞患者院前延迟时间的因素

目的探讨影响急性心肌梗塞(AMI)患者院前延迟时间(PDT)的相关因素.方法收集461例AMI患者,剔除47例资料不全者,将入选414例分为PDT≤6 h组221例,PDT>6 h组193例.分析包括性别、年龄、高血压史、糖尿病史、高血脂、吸烟史、既往心绞痛史、发病时间、主要症状、PDT,入院时心功能、梗塞部位等.结果①PDT>6h组较PDT≤6h组年龄大、女性患者比例高、糖尿病史者比例高、既往有心绞痛史者多、夜间发病者比例高,2组比均有显著性差异,P<0.05～0.01.但典型胸痛症状和入院时心功能不全PDT>6 h组较PDT≤6 h组比率低,2组均有显著性差异,P<0.05～0.01;②多元逻辑回归分析显示年龄、糖尿病史、既往心绞痛病史、发病时间及入院时心功能不全为影响PDT的独立相关因素.结论年龄、糖尿病史、心绞痛病史、发病时间及入院时心功能不全为影响AMI患者PDT的独立相关因素.     

静脉溶栓治疗急性右室心肌梗塞的疗效观察

目的探讨静脉溶栓治疗急性右室心肌梗塞之临床疗效及安全性。方法连续选择4年内649例AMI患者中，67例右室AMI（均合并下、后壁心肌梗塞）患者诊治资料，进行各亚组疗效比较。结果（1）67例右室AMI患者中，42例接受溶栓治疗，高于平均接受率（62．7％比46．1％，P＜0．01）。（2）未接受溶栓治疗之患者中，右室AMI在住院期病死率（28．0％比13．6％）、右心衰合并左心功能不全≥KillipⅢ级（60％比32．6％）及恶性心律失常发生率（44％比21．8％）均比非右室AMI患者明显为高（P＜0．05～0．01）。（3）右室AMI患者比非右室组，在溶栓后的病死率（-20．9％比-7．4％）、心功能≥Ⅲ级（-31．4％比-19．0％）及严重心律失常发生率（-25．0％比-11．7％）的净减少率均更为显著（P＜0．05～0．01）。结论右室AMI患者接受静脉溶栓治疗安全、有效，并比非右室AMI患者得益更大。