非糖尿病扩张型心肌病心力衰竭患者胰岛素抵抗、血清ST2与心功能相关性及临床意义

目的探讨非糖尿病扩张型心肌病慢性心力衰竭患者胰岛素抵抗（IR）、血清ST2水平与心功能相关性及临床意义。方法入选56例非糖尿病扩张型心肌病患者,冠状动脉造影排除缺血性心肌病。按NYHA心功能分级分为三组（心功能Ⅱ级、心功能Ⅲ级、心功能Ⅳ级组）。健康对照组48例。用葡萄糖氧化酶法测定空腹血糖,放射免疫法测定空腹胰岛素,并计算出胰岛素抵抗指数（HOMA-IR）;酶联免疫方法测定NT-proBNP、ST2水平结果 1.心衰组HOMA-IR、ST2均高于正常对照组（P〈0.05）;2.不同心功能组HOMA-IR、ST2有显著性差异（P〈0.05）,随心衰程度加重而进行性升高;3.HOMA-IR与LVEF呈负相关（r=-0.524p〈0.01）;与LVEDd呈正相关（r=0.329p〈0.01）;与NT-proBNP呈正相关（r=0.466p〈0.01）;4.血清ST2水平与LVEF呈负相关（r=-0.258p〈0.01）;与LVED呈正相关（r=0.234p〈0.01）;与NT-proBNP呈正相关（r=0.359p〈0.01）;5.HOMA-IR与血清ST2水平呈正相关（r=0.287p〈0.01）。结论非糖尿病扩张型心肌病心力衰竭患者HOMA-IR、血清ST2水平与心功能密切相关,且随心功能恶化而升高;IR可能与ST2存在内在联系;IR可能是HF的易患因素之一。

Non-diabetic patients with dilated cardiomyopathy heart failure insulin resistance, serum ST2 cardiac function and clinical significance

Objective To explore the levels and clinical significance of insulin resistance(IR),serum ST2 in dilated cardiomyopathy with chronic heart failure patients who without diabetes mellitus Methods Selected 56 patients with heart failure diagnosed of dilated cardiomyopathy,using coronary angiography to rule out ischemic cardiomyopathy.They were divided into three groups according to NYHA class(NYHA classⅡ,Ⅲ,Ⅳ).48 healthy cases as control group.Fasting plasma glucose was tested by glucose oxidase method,fasting insulin was measured by radioimmunoassay,and then calculated insulin resistance index(HOMA-IR);enzyme-linked immunosorbent method was used to test NT-proBNP、ST2 levels.Results 1.Compared with the normal control group,HOMA-IR,、ST2 were higher in heart failure group(P <0.05);2 There were significant difference of HOMA-IR and ST2 different heart function group(P <0.05),They increased with heart failure deterioration;3 HOMA-IR were negatively correlated with LVEF(r =-0.524,p <0.01);positively correlated with LVEDd(r = 0.329,p <0.01);positively correlated with NT-proBNP(r= 0.466 p <0.01);4.serum ST2 level was negatively related with LVEF(r =-0.258 p<0.01);and positively correlated with LVED(r = 0.234 p<0.01);and positively correlated with NT-proBNP(r =0.359 p <0.01);5.HOMA-IR positively correlated with ST2 level was(r = 0.287 p <0.01).Conclusion HOMA-IR and ST2 levels closely related with cardiac function in dilated cardiomyopathy with chronic heart failure patients who without diabetes mellitus,and increased with cardiac function deterioration.IR may be intrinsically linked with ST2,IR was one of risk factors of HF.