胰岛素抵抗对冠心病患者血管内皮功能的影响

目的探讨胰岛素抵抗对冠心病患者血管内皮功能的影响，了解伴有或不伴有胰岛素抵抗患者内皮功能的差异，并指导治疗。方法将90例住院的冠心病患者经测定空腹血糖和血浆胰岛素水平后分成3组，第1组（30例）：非胰岛素抵抗的冠心病患者；第2组（30例）：伴胰岛素抵抗的冠心病患者未经治疗者；第3组（30例）：治疗组，予二甲双胍0．5g，3次／d，口服4周。分别观察3组在治疗前后内皮功能指标（ET、NO、TXB2、6-keto-PGF1α）和血浆肾素、血管紧张素的变化。结果3组统计显示：伴有胰岛素抵抗的冠心病患者其内皮功能指标明显差于不伴有胰岛素抵抗的患者，并且经治疗后，随着胰岛素抵抗的改善，其内皮功能指标也有一定的改善。结论胰岛素抵抗与冠心病患者的血管内皮功能密切相关，改善了胰岛素的抵抗就可能会改善冠心病患者的血管内皮功能，从而改善预后。

Effect of insulin resistance on the vascular endothelial function in the patiens with coronary heart disease

Objective To observe the effect of insulin resistance on the vascular endothelial function in the patiens with coronary heart disease. Methods 90 patients with coronary heart disease were divided to three groups by the level of plasma insulin and blood glucose. There were 30 cases of normal insulin sensitivity,30 cases of insulin resistance without treatment and 30 cases of insulin resistance with treatment by Mefformin. The dosage of Mefformin was 0. 5 g, bid, po. The course of treatment is 4 weeks. The plasma angiotensin Ⅱ (ATII), rennin and the vascular endothelial function such as the concentrations of serum ET, NO, TXB2 ,6-keto-PGI2 were detected for the patients of three groups before arid after treatment. Results There was very difference of the vascular endothelial function in patients with coronary heart disease between the casess with insulin resistance and the casess without insulin resistance. The vascular endothelial function can be elevated by the improvement of insulin resistance after treatment. Conclusion There is closely relationship in patients with coronary heart disease between the vascular endothelial function and the insulin resistance. The patients with coronary heart disease can be helpful throughout the elevation of vascular endothelial function by the improvement of insulin resistance.