急诊冠状动脉介入治疗后无复流现象与胰岛素抵抗

目的探讨急性心肌梗死（AMI）急诊经皮冠状动脉介入治疗（PCI）后心肌无复流现象与胰岛素抵抗之间的关系。方法行急诊PCI的ST段抬高型AMI患者109例，其中单光子发射型计算机断层（single photon emission computed tomography，SPECT）心肌灌注显像检测出现心肌无复流现象的22例。测定空腹血糖、空腹胰岛素水平、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、肌酐、尿酸水平。评价胰岛素敏感性采用稳态模式评估法（HOMA）及改良的胰岛素敏感性指数（ISI）公式计算。结果AMI无复流组与复流组比较，存在高胰岛素血症（P〈0．05）和胰岛素敏感性的降低（P〈0．05）。结论AMI急诊PCI术后出现心肌无复流现象的患者存在高胰岛素血症和胰岛素抵抗，胰岛素抵抗在心肌无复流现象的发病中可能发挥一定作用。

Relationship Between Insulin Resistance and No-reflow in Patients with Acute Myocardial Infarction

Objective To explore the relationship of insulin resistance and no-reflow after treatment with emergency percutaneous coronary intervention(PCI) in ST-elevant acute myocardial infarction. Methods Observing parameters fasting blood glucose(FBG),insulin(INS),total cholesterol(TC),triglycerides(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),creatinine(Cr),uricacid(UA),blood pressure and body mass index(BMI) in 109 cases of acute myocardial infarction. The status of insulin resistance was assessed by homeostasis model assessment(HOMA) and the improved insulin sensitivity index(ISI). Results Fasting insulin levels were significantly higher and insulin sensitivity was lower in no-reflow groups than in reflow groups(P<0.05). Conclusion Patients with no-reflow have an increase in fasting insulin,a decrease in insulin sensitivity. Insulin resistance may play a role in it.