胰岛素抵抗及氧化应激对急性冠脉综合征患者冠脉病变评估的研究

目的 探讨胰岛素抵抗及氧化应激对急性冠状动脉综合征（ACS）患者病情评估的价值及与冠脉病变程度的相关性.方法 入选急性心肌梗死患者30例为A组,不稳定型心绞痛患者30例为B组,冠脉造影正常者30例为C组.对各组受试者于入院24h内空腹抽取静脉血,测定入选患者血清脂质过氧化物（MDA）、一氧化氮（NO）、一氧化氮合酶总活力（tNOS）、诱导型一氧化氮合酶（iNOS）、空腹血糖（FPG）、空腹胰岛素（FINs）水平,均采用分光比色法.计算胰岛素抵抗指数（HOMA-IR）,对入选患者行冠脉造影检查,根据冠脉造影结果所显示的血管狭窄程度及部位计算Gensini积分值.对胰岛素抵抗及氧化应激指标与冠脉Gensini积分进行相关性分析.结果 FPG、FINs、HOMA-IR、MDA、Gensini积分急性心肌梗死组高于不稳定型心绞痛组及冠脉造影正常组,差异具有统计学意义（P＜0.05）;而tNOS、iNOS、NO急性心肌梗死组低于不稳定型心绞痛组及冠脉造影正常组,差异具有统计学意义（P＜0.05）;急性心肌梗死组及不稳定型心绞痛组FPG、FINs、HOMA-IR、MDA、Gensini积分均高于冠脉造影正常组,而NO、tNOS、iNOS均低于冠脉造影正常组,差异具有统计学意义（P＜0.05）;急性心肌梗死组及不稳定型心绞痛组HOMA-IR与MDA、Gensini积分呈正相关,与NO、tNOS、iNOS呈负相关.结论 胰岛素抵抗与氧化应激反应与急性冠状动脉综合征（ACS）患者病情密切相关,且与冠脉病变程度呈正相关.

Evaluation value of insulin resistance and oxidative stress on coronary artery disease in patients with acute coronary syndrome

Objective To investigate the evaluation value of insulin resistance and oxidative stress predictive value for acute coronary syndrome （ACS）, and the eorrelationwith the severity of coronary artery disease. Methods 30 patients with acute myocardial infarction（AMI） in group A, unstable angina pectoris group of 30 patients in group B, normal coronary angiography group of 30 patients in group C were investigated. For each group, fasting venous blood was drawn when subjects were admitted to hospital 24 hours, serum lipid peroxide（MDA）, nitric oxide synthase total energy （tNOS）, induced nitric oxide synthase（iNOS） activity and nitric oxide（NO） lev- el, fasting plasma glucose （FPG） and fasting insulin （FINs） levelwere measured with the method of Spectrophoto- metric colorimetry, and the indexes of insulin resistance （HOMA-IR） was calculated.All patients undergone with coronary angiography , and the Gensini score was calculated according to the results of coronary angiography. Re- suits FPG, FINs, HOMA-IR, MDA, Gensini points in patients with acute myocardial infarction were higher than unstable angina pectoris group and normal coronary anglography group （P〈0.05）, and tNOS, iNOS, NO in patients with acute myocardial infarction were lower than unstable angina pectoris and normal coronary angiography group （P〈0.05）. In acute myocardial infarction and unstable angina pectoris group, FPG, FINs, HOMA-IR, MDA and Gensini score were higher than normal coronary anglography group, tNOS, iNOS and NO were significantly lower than normal coronary angiography group （P〈0.05）. In acute myocardial infarction and unstable angina pectoris group, HOMA-IR was positive correlated with MDA and Gensini score, and negative correlated withNO, tNOS and iNOS. Conclusion Insulin resistance and oxidative stress were positively correlated with the degree of coronary artery lesions.