胰岛素抵抗对非ST段抬高急性冠脉综合征患者的影响

目的　探讨胰岛素抵抗 (IR)对老年非ST段抬高急性冠脉综合征 (ACS)患者临床表现的影响。 方法　 70例老年非ST段抬高的ACS患者 ,分为血糖正常 (NGT)组、糖耐量低减 (IGT)组及糖尿病 (DM )组。所有患者详细询问病史 ,检测血肌钙蛋白 (CTnT)、血糖、血脂、空腹血胰岛素等 ,计算胰岛素敏感性指数 (IAI)。冠脉病变用冠状动脉造影 (CAG)分析 ,心功能用超声心动图测左室射血分数 (LVEF)评定。　 结果　IGT组与DM组间除空腹血糖及餐后 2h血糖、IAI有显著差异外 (P <0 0 1) ,其他均无显著差异 ;IGT组及DM组 (IR相对严重组 )与NGT组 (IR相对较轻组 )比较 :多支冠脉病变的发生率 (71 4%、67 7%比 2 5 0 % )、冠脉远端病变率 (4 2 9%、42 9%比 14 3 % )、心功能减退 (71 4%、76 2 %比 3 2 1% )、3 0d内心脏事件发生率 (3 3 3 %、2 8 6%比 3 6% )、CTnT阳性率 (4 7 6%、5 7 1%比 2 5 0 % ) ,均有显著差异 (P <0 0 1) ,而IGT与DM组间各项均无显著差异。　 结论 　IR相对较重患者多支病变的发生率明显升高 ,病变多呈弥漫性 ,远端血管病变发生率高 ,CTnT阳性率高 ,心功能较差 ,预后不良。

Effects of insulin resistance on clinical characteristics of elderly cases of acute coronary syndrome without ST segment elevation

Objective To explore the effects of insulin resistance on clinical characteristics of elderly patients with acute coronary syndrome(ACS)without ST segment elevation. Methods Seventy patients with ACS without ST segment elevation were divided into 3 groups:normal glucose tolerance patients(NGT group,28 cases),impaired glucose tolerance patients(IGT group,21 cases),diabetes mellitus patients(DM group,21 cases).Coronary angiographies(CAG) and assay of CTnT,fasting blood glucose(FPG)and insulin(FIN),TG,TC,HDL-C and LDL-C measurements were performed in all subjects;IAI was calculated.Coronary lesions were evaluated with CAG,and the left ventricular ejection fraction (LVEF)was measured with echocardiography.The episodes of cardiac events within 30 days were recorded simultaneously. Results The combined lesions in the coronary arteries,the rate of CTnT positive were more frequent in group IGT and DM(the more insulin resistant subjects) patients than NGT (the less insulin resistant subjects)ones(71.4%,67.7% vs 25.0%),(47.6%,57.1% vs 25.0%) respectively.The incidence of LVEF<50% displayed decreased cardiac functions,the incidence of cardiac events within 30 days occurs more frequently in IGT and DM group than NGT group (71.4%,76.2% and 32.1%),(33.3%,28.6% and 3.6%),respectively. Conclusions The elderly cases of ACS without ST segment elevation who present with severe insulin resistance have more opportunity to suffer from combined lesion in the coronary arteries and cardiac events.