急性心肌梗死患者胰岛素抵抗与冠状动脉病变关系的初步研究

目的: 探讨急性心肌梗死患者胰岛素抵抗与冠脉病变的关系。方法: 纳入接受直接经皮冠状动脉支架置入术（PCI）的急性心肌梗死患者153例，分别检测其甘油三酯（TG）、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白（HDL）、同型半胱氨酸（HCY）、超敏C反应蛋白（hs-CRP）、空腹血糖（FPG）、空腹胰岛素（FINS）、肌酐水平，应用SYNTAX积分、罪犯血管、病变支数、支架长度及直径评价冠脉病变情况，分析胰岛素抵抗与冠脉病变的相关性。 结果: 胰岛素抵抗患者体质指数（BMI）、TC、TG、LDL、HCY、hs-CRP、FPG、FINS、冠脉支架长度、SYNTAX积分、高血压患病率、吸烟构成比均高于敏感患者，差异有统计学意义，在年龄、肌酐、高密度脂蛋白、性别构成比、糖尿病患病率及罪犯血管、病变支数、支架直径方面差异无统计学意义，各因素在不同胰岛素抵抗程度方面亦无明显差异，Pearson线性相关及多因素线性回归分析显示，BMI、TG、TC、LDL、CRP、FPG、FINS、SYNTAX积分与胰岛素抵抗指数HOMA-IR呈显著正相关， BMI、TG、LDL、CRP是影响胰岛素抵抗指数的主要因素。结论: 胰岛素抵抗加重急性心肌梗死患者冠脉血管病变范围及程度。

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Relationship of insulin resistance and coronary artery disease in patients with acute myocardial infarction

?Objective:To study the relationship of insulin resistance and coronary artery disease in acute myocardial infarction (AMI). Methods:According to the HOMA-IR,153 patients with AMI accepted PCI, were divided into insulin resistance group and sensitive group. Triglyceride（TG）, cholesterol（TC）, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), homocysteine (HCY), hypersensitive c-reactive protein (hs-CRP), fasting glucose(FPG), fasting insulin（FINS）,creatinine were detected, coronary artery lesions were evaluated by the SYNTAX integral , and the criminal vascular and lesion counts, stent length and diameter were recorded.And the correlation between insulin resistance and above factors were analyzed. Results: For insulin resistance patients, BMI, TG, TC, LDL , HCY, hs-CRP, FPG, FINS, stent length, SYNTAX score, hypertension prevalence, smoking were higher, and differences were statistically significant. Differences in age, creatinine, HDL, sex，diabetes prevalence and criminals vascular, lesion counts, diameter had no statistical significance.Factors with different degree showed no significant differences.Pearson correlation analysis and multi-factor stepwise linear regression analysis showed that BMI,TC,TG,LDL,CRP,FPG,FINS, SYNTAX integral and HOMA-IR were significantly positively correlated，and BMI,TG,LDL,CRP were the main influencing factors. Conclusion: Insulin resistance can aggravate the range and degree of coronary vascular lesion.