胰岛素抵抗对冠心病患者冠状动脉病变严重程度的影响

【目的】探讨胰岛素抵抗作为冠心病的危险因素与冠脉病变严重程度的关系。【方法】采用回顾性研究，收集358例住院并行冠脉造影确诊冠心病的患者病例，根据稳态模型胰岛素抵抗指数（HOMA—IR）分为胰岛素抵抗（IR）组和胰岛素敏感（IS）组，分析胰岛素抵抗对冠状动脉病变严重程度的影响。【结果】IR组重度狭窄病变、复杂病变、弥漫性病变、C型病变发生率高（P〈0．05）。IR组Gemini积分、病变血管支数、病变数高于IS组（P〈0．05）。经Spearman相关分析表明HOMA—IR与Gemini积分呈正相关。经多元线性回归分析表明：HDL—C为冠状动脉病变的保护因素，收缩压、LDL—C、HOMA—IR为冠状动脉病变的危险因素。【结论】HOMA—IR可以预测或提示冠状动脉病变严重程度，IR患者冠状动脉病变严重，弥漫病变、复杂病变、重度狭窄病变发生率高。

Effects of insulin resistance on the severity of coronary artery lesion in coronary artery disease patients

Objective] To investigate the relationship between insulin resistance as a risk factor of coronary artery disease and the severity of coronary artery lesion. Methods] All data were taken from the hospitalized coronary artery disease cases operated on coronary angiography from April. 2005 to December.2007. The patients were divided into IR gronp and IS group according to the HOMA- IR. The relationship between insulin resistance and the severity of coronary artery lesion were analyzed retrospectively. Results] The incidences of high-grade stenosis lesion, complex lesion, diffuse lesion, C type lesion in IR group were higher than that in IS group （ P 〈0.05）. The levels of Gensini score, number of lesion vessel, and lesion amount in IR group were higher than in KS group （ P 〈 0. 05）. The positive correlation was found between HOMA - IR and Gemini score by Spearman correlation analysis. HDL- C was a protecting factor for coronary artery lesion, and systolic blosd pressure, LDL- C, HOMA- IR were risk factors by multiple linear regression analysis. Conclusions] HOMA- IR may indicate the severity of coronary artery lesion severity. The IR patients are often accompanied with severe lesions and higher incidence of diffuse, complex and high-grade stenosis lesions.