胰岛素抵抗与急性心肌梗死患者梗死相关动脉自发再通的关系

目的 探讨糖耐量正常且伴发急性ST段抬高型心肌梗死患者胰岛素抵抗与梗死相关动脉早期血流自发再通的关系.方法 连续入选141例糖耐量正常且伴发急性ST段抬高型心肌梗死患者,根据急诊冠状动脉造影结果 分为TIMI 0～1级组(91例)和,TIMI 2～3级组(50例).计算病变支数和Gensini得分,测定代谢参数和hs-CRP,计算胰岛素抵抗指数(IRI),进行相关统计分析.结果 血流TIMI 0～1级组的空腹胰岛素[(11.52±6.22)mU/L]、IRI(2.79±2.32)和Gensini得分[(59.17±26.95)分]显著高于TIMI2～3级组[(7.54±3.65)mU/L、(1.73±1.26)和(38.46±22.74)分](P均<0.01).IRI和Gensini得分呈显著正相关(r=0.185,P<0.05).Logistic回归分析提示,IRI是影响梗死相关动脉血流自发再通的独立危险因素(OR=2.87,95%CI为1.09～7.57,P<0.05).结论 胰岛素抵抗是影响搪耐量正常且伴发急性ST段抬高型心肌梗死患者梗死相关动脉早期血流自发再通的独立危险因素.

Association of insulin resistance with spontaneous recanalization of infarct-related arteries in patients with a-cute myocardial infarction

Objective To clarify the role of insulin resistance on spontaneous recanalization of infarct-relat-ed arteries in the early phase of acute ST-elevation myocardial infarction (STEMI) in patients with normal glucose tolerance. Methods 141 consecutive patients with normal glucose tolerance and acute STEMI were enrolled in our study. Subjects were divided into TIMI 0-1 group (n =91 ) and TIMI 2-3 group (n =50) by primary coronary angi-ngraphy (CAG). The Gemini score and 0-3-vessel disease score estimated the severity and extent of coronary artery disease (CAD). Metabolic parameters and homeostasis model assessment for insulin resistance (IRI) were deter-mined. Results Serum level of fasting insulin, IRI and Gemini score were higher in TIMI 0-1 group than in TIMI 2-3 group [ (11.52±6.22)mU/L vs (7.54±3.65)mU/l,(2.79±2.32) vs (1.73±1.26),(59.17±26.95) vs ( 38.46±22.74) ( P <0.01)]. IRI was positively associated with Gemini score (r=0.185,P <0.05 ). Multivariate Logistic regression analysis revealed that IRI was independent risk factor influencing spontaneous recanalization of in-farct-related urteries(OR=2.87,95% CI=1.09-7.57,P<0.05). Conclusion Insulin resistance is independent risk factor influencing spontaneous recanalizafion of infarct-related arteries in the early phase of acute STEMI in pa-tients with normal glucose tolerance.