冠心病血浆内皮素水平与胰岛素敏感性的关系

目的 :了解冠心病患者血浆内皮素 (ET)水平与胰岛素敏感性之间的关系。　　方法 :对 77例冠心病患者 (冠心病组 )和 2 0例健康人 (正常对照组 )行口服葡萄糖耐量试验、胰岛素和 C肽释放试验 ,并测定空腹血浆 ET。以血浆 ET水平为因变量、9个胰岛素敏感性指标为自变量分别进行单元直线相关分析和多元逐步回归分析。　　结果 :冠心病组血浆 ET显著高于正常对照组 (P<0 .0 1) ;两组空腹血葡萄糖无显著性差异 ;冠心病组胰岛素敏感性指数小于正常对照组 (P<0 .0 1) ;其它指标大于正常对照组 (P<0 .0 5～ 0 .0 1)。冠心病组血浆 ET与多个胰岛素敏感性指标显著相关 ,但独立相关的指标只有胰岛素敏感性指数、空腹血胰岛素和 (或 ) C肽曲线下面积。　　结论 :血浆 ET水平升高和胰岛素敏感性减低普遍存在于冠心病 ,而且血浆 ET水平与胰岛素敏感性相关 ,提示 ET和胰岛素抵抗在冠心病的发病机制中可能具有一定的内在联系。

Interrelation between Plasma Level of Endothelin and Insulin-Sensitivity in Patients with Coronary Heart Disease

Objectives:To assess the relationship between plasma endothelin (ET) levels and insulin sensitivity in patients with coronary heart disease (CHD). Methods:Twenty healthy subjects (control group) and 77 CHD patients (CHD group) were studied.Venous blood samples were taken during fasting and at different time points after glucose load (100g).Samples were analyzed for glucose,immunoreactive insulin and C peptides.Fasting samples in all subjects were also analyzed for immunoreactive ET.Correlations between ET level and each of nine insulin sensitivity items were obtained using linear regression analysis,and multivariate regression analysis was used to assess independence of associations. Results:CHD group had significantly higher plasma ET level than control group.There was no statistical difference in fasting serum glucose level between the two groups.CHD group had remarkably less insulin sensitivity index than control group,while other items were higher than the control.Linear regression analysis showed that plasma ET level was significantly correlated with many of the insulin sensitivity parameters in CHD group.In multivariate regression analysis,however,independently correlated factors included insulin sensitivity index,fasting serum insulin and(or) area under C peptide curve. Conclusion:Elevated circulating ET level and declined insulin sensitivity extensively exist in CHD patients.There is a closely positive correlation between ET level and insulin resistance.There might be certain intrinsic associations between ET and insulin resistance in the pathophysiology of CHD.