胰岛素抵抗对冠脉血管病变的影响

目的探讨冠心病不同程度冠脉病变时胰岛素敏感性指数、血清脂质的变化及意义.方法 29例冠心病同时合并糖尿病的病人,按冠脉主要分支最大狭窄程度和斑块病变类型不同分为明显病变组(SG)和轻度病变组(MG),另取同期冠脉造影正常非冠心病者16例为对照组(CG).测定各组空腹血糖、胰岛素和餐后2 h血糖、胰岛素,胰岛素敏感性指数,血清脂质的变化.结果空腹血糖、胰岛素和餐后2 h血糖、胰岛素,胰岛素敏感性指数,血清脂质水平,冠心病同时合并糖尿病的病人显著高于健康对照组(P<0.05, P<0.01),且冠脉明显病变组显著高于冠脉轻度病变组(P<0.05).结论上述各参数变化可能与冠心病冠脉病变程度有一定关系,胰岛素抵抗的发生可严重影响冠脉病变的程度.

Effects of insulin resistance on coronary arterial lesion in diabetic patients with coronary heart disease

Objective To investigate the changes of insulin sensitivity index and serum lipid in coronary heart disease (CHD) with various degrees of coronary arterial lesion and their significance. Methods A total of 29 CHD patients with diabetes were divided into 2 groups according to the degrees of the maximal stenosis of the major coronary artery branch and the angiographic morphology of plaques: severe lesion group (SG, narrowness of luminal diameter >50% and types 2 and 3 of plaque morphology) and mild lesion group (MG, narrowness of luminal diameter <50% and type 1 of plaque morphology). Meanwhile, normal coronary angiographs of 16 healthy people served as the control group (CG). The serum levels of fasting plasma glucose and fasting insulin, 2 h postprandial plasma glucose and insulin levels, insulin sensitivity index and serum lipid in each group were determined. Results The serum levels of fasting plasma glucose and fasting insulin, 2 h postprandial plasma glucose and insulin levels, and insulin sensitivity index and serum lipid in CHD patients with diabetes were significantly higher than those in CG ( P <0 05). The parameters mentioned above in SG were markedly higher than those in MG. Conclusion The changes of serum levels of fasting plasma glucose and fasting insulin, 2 h postprandial plasma glucose and insulin levels, insulin sensitivity index and serum lipid may be associated with coronary arterial lesion of CHD patients. Insulin resistance may deteriorate coronary arterial lesion in CHD patients with diabetes.