胰岛素抵抗和纤溶功能紊乱与急性冠状动脉综合征的相关性研究

目的探讨胰岛素抵抗(IR)、纤溶功能紊乱与急性冠状动脉综合征(ACS)患者冠状动脉病变严重程度的关系及对患者近期预后的预测价值。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ACS的患者165例,按IR指数(HOMA指数)水平分为两组,IR组(HOMA-IR>5)80例,非IR组(HOMA-IR≤5)85例,分析两组患者间纤溶功能指标、冠状动脉病变严重程度的差异,并观察纤溶功能紊乱及IR对接受经皮冠状动脉介入治疗(PCI)的ACS患者近期(6个月内)预后的影响。结果与非IR组比较,IR组ACS患者组织纤溶酶原激活物(t-PA)水平较低(8.56±2.39)μg/L比(11.06±2.12)μg/L,P<0.01],纤溶酶原激活物抑制物1(PAI-1)水平较高(36.21±9.62)μg/L比(22.12±3.97)μg/L,P<0.01],并且冠状动脉病变的严重程度增加:多支病变26例(32.5%)比13例(15.3%),P<0.05];B2/C型病变29例(36.3%)比17例(20.0%),P<0.05];Gensini积分(55.63±14.24比44.11±11.42,P<0.01)。IR与PAI-1呈正相关(r=0.293,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(P<0.05)。结论 ACS患者存在纤溶功能紊乱或IR时,冠状动脉病变更为严重,PAI-1水平及IR对ACS患者的近期预后有预测价值。

Relationship between insulin resistance,disturbance of fibrinolysis-coagulation system and severity of coronary artery disease in patients with acute coronary syndrome

Objective To investigate the relationship between insulin resistance （IR）, disturbance of fibrinolysis- coagulation system and severity of coronary artery disease and their predictive value of prognosis in patients with acute coronary syndrome （ACS）. Methods A total of 165 ACS patients were included and divided into two groups according to homeostasis model assessment （HOMA） index： IR group （ HOMA-IR 〉 5） and Non-IR group （ HOMA-IR 〈5）. Plasma tissue plasminogen activator （t-PA） and plasminogen activator inhibitor-1 （PAI-1） were measured by ELISA. The severity of coronary artery lesions were assessed by Gensini score. All patients were followed up for 6 months and MACE including death, nonfatal myocardial infarction, angina, arrhythmia and heart failure were recorded. Results Compared to Non-IR group, patients in 1R group had significantly higher plasma PAI-1 level （ 36. 21 ± 9. 62 ） μg/L vs. （ 22. 12 ± 3.97 ） μg/L, P 〈0. 01 ], lower t-PA level （8.56 ± 2. 39） μg/L vs. （ 11.06 ± 2. 12） μg/L, P 〈 0. 01 ] and higher Gensini score （55.63 ± 14. 24） vs. （44. 11 ± 11.42）, P 〈 0. 01 ） ]. PAI-1 was positively correlated with IR （ r = 0. 293, P 〈 0. 01）. Both PAI-1 and IR were strong independent predictors of prognosis in ACS patients received PCI （P 〈 0. 05）. Conclusions Both disturbance of fibrinolysis-coagulation system and IR are correlated with the severity of coronary artery disease. PAI-1 and IR are independent predictors of prognosis in ACS patients.