非糖尿病患者胰岛素抵抗与冠脉病变严重程度的相关性分析

目的：探讨不合并糖尿病的冠心病（CHD）不稳定心绞痛（UAP）患者胰岛素抵抗（IR）与冠状动脉（冠脉）病变严重程度的相关性。方法：将连续的224例接受冠脉造影检查的非糖尿病患者根据病变冠脉受累支数分组：单支病变组、双支病变组、多支病变组和正常对照组。测量身高、体重、腹围，测定空腹血糖（FPG）、空腹胰岛素（FINS）、纤维蛋白原（Fbg）、白细胞计数（WBC）、尿酸（UA）、血脂、总胆红素（TBIL）等，计算体重指数（BMI）、稳态模型评估-胰岛素抵抗指数（HOMA-IR）和Gensini积分。根据Gensini积分评价冠脉病变严重程度，根据HOMA—IR评价IR。结果：冠心病多因素Logistic回归分析显示，HOMA—IR、性别、年龄、TBIL、LDL—C、HDL—c、Fbg、高血压均是CHD的独立危险因素。冠心病组校正影响因素后进行偏相关分析显示，HOMA—IR与Gensini积分显著正相关（r=0．223，P=0．024）；多元逐步线性回归分析显示，HOMA—IR、年龄、LDL—C与Gensini积分独立相关。结论：非糖尿病患者IR是冠心病的独立危险因素，且与冠脉病变严重程度密切相关。

Study on the relationship between insulin resistance and severity of coronary artery lesion in non-diabetic patients

Objective： To investigate the relationship between insulin resistance and severity of coronary artery lesion in non-diabetic patients with unstable angina. Methods： Totally consecutive 224 non-diabetic patients received coronary angiography were enrolled, who were divided into four groups according to the number of diseased vessels： one vessel diseased group, two vessels diseased group, three vessels diseased group and control group. The height, weight, waist circumference （WC） were measured. Plasma insulin （FINS）, fasting plasma glucose （FPG）, fibrinogen （Fbg）, white blood cell count （WBC）, serum uric acid （UA）, serum lipids and serum total bilirubin （TBIL） were measured. Body mass index （BMI）, homeostasis model assessment of insulin resistance index （HOMA-IR） and Gensini＇s score of coronary artery were also calculated. Following angiography, the severity of coronary artery lesion was assessed by the number of diseased vessels and Gensini＇s score. The severity of insulin resistance was assessed by HOMA-IR. Results： Binary Logistic regression showed that HOMA-IR, sex, age, TBIL, LDL-c, HDL-c, Fbg and hypertension were independent risk factors for predicting CHD. Partial correlations showed that HOMA-IR was positively and significantly correlated with Gensini＇s score （r =0.223, P=0.024）after adjusting the influential factors. Multivariate linear regression model showed that HOMA-IR, age and LDL-c were independent factors for Gensini＇s score. Conclusion：Insulin resistance is a independent risk factor for coronary heart disease and is closely correlated with the severity of coronary artery stenosis in non-diabetic patients with unstable angina.