胰岛素抵抗、组织纤溶酶原激活物抑制物-1与急性冠脉综合征的相关性研究

目的 探讨胰岛素抵抗（IR）、组织纤溶酶原激活物抑制物-1（PA1-1）与急性冠脉综合征（ACS）患者冠脉病变严重程度的关系及对患者近期预后的预测价值,并分析IR与PA1-1的相关性.方法 连续收集2008年2月至2009年7月在我院心内科住院并诊断为ACS的患者165例,按胰岛素抵抗指数水平（HOMA指数）分为2组：胰岛素抵抗（IR）组（HOMA-IR＞5）80例,非IR组（HOMA-IR≤5）85例.分析两组ACS患者间PAI-1水平、冠脉病变严重程度的差异,并观察PAI-1水平及IR对接受经皮冠脉内介入治疗术（PCI）的ACS患者近期预后（6个月）的影响.结果 IR组ACS患者与非IR组相比,PAI-1水平明显升高,且冠脉病变严重程度增高,组间差异有统计学意义（P＜0.05或P＜0.01）;多因素Logistic回归分析显示,PAI-1及IR均是ACS患者近期预后的独立预测因子.结论 纤溶功能紊乱、IR与ACS患者冠脉病变的严重程度相关,PAI-1水平及IR对ACS患者的近期预后有预测价值.

Relationship of unsulin resistance, plasminogen activator inhibitor-1 and the severity of acute coronary syndrome

Objective To investigate the relationship of Insulin resistance（IR） and Plasminogen activator inhibitor-1 （PAl-1 ） to the severity of acute coronary syndrome （ACS）, and the predictive value of IR and PAl-1 to ACS patient＇s recent prognosis. Methods 165 ACS patients were selected and divided into two groups accord- ing to their HOMA index： IR group （HOMA-IR〉5）, Non-IR group（HOMA-IR~〈5）. The differences of PAI-1 and the severity of coronary artery lesions between two group were assessed. Results The level of PAl-1 and the severity of coronary artery lesions in IR group were higher than Non-IR group＇s, and the t-PA level was lower than Non-IR group. PAI-1 and IR were positive correlated. Both PAI-1 and IR were strong independent predictors for the prognosis of ACS patients received PCI treatment. Conclusion PAl-1 and IR correlate with the severity of coronary artery lesions in ACS patients. They may be valuable in predicting the prognosis of ACS patients.