胰岛素抵抗、糖化血红蛋白及血糖对冠状动脉病变的影响

目的观察胰岛素抵抗、糖化血红蛋白及血糖与冠状动脉病变之间的关系。方法回顾性分析本院179例因怀疑为冠心病而行冠状动脉造影患者的临床资料,根据冠状动脉病变支数,分为无病变组、单支病变组、双支病变组和多支病变组。根据Gensini积分评估冠状动脉病变的严重程度,空腹静脉血测定血浆胰岛素（FINS）、血糖（FPG）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL）、低密度脂蛋白胆固醇（LDL）、载脂蛋白A（ApoA）及载脂蛋白B（ApoB）,餐后2h静脉血测定餐后2h血糖（2hPPG）,采用HOMA-IR来评估机体的胰岛素抵抗程度。结果①Gensini积分与FPG、LDL、HbA1c及2hPPG成显著正相关（P〈0.01）,与年龄、ApoB及HOMA-IR成正相关（P〈0.05）,与DBP成负相关（P〈0.01）;②病变支数与年龄、FPG、LDL、HbA1c及2hPPG成显著正相关（P〈0.01）,与UA、ApoB及HOMA-IR成正相关（P〈0.05）;③年龄与DBP成显著负相关（相关系数-0.224,P〈0.01）,与ApoB成负相关（相关系数-0.193,P〈0.05）;④HOMA-IR与FPG、2hPPG、FINS、ApoB及HbA1c成显著正相关（P〈0.01）,与LDL成正相关（P〈0.05）。校正性别、年龄、SBP、DBP、UA、TG、HDL、TC、LDL、ApoA及ApoB影响后,HOMA-IR、FPG、HbA1c、2hPPG与病变支数、Gensini积分仍成正相关（P〈0.05）。结论胰岛素抵抗、HbA1c及血糖水平的升高是冠心病的危险因素,应该早期干预。

The Effect of Insulin Resistance,Glycated Hemoglobin and Plasma Glucose in Coronary Lesions

Objective To observe the relationship between insulin resistance,glycated hemoglobin and plasma glucose with coronary lesions.Methods 179 patients who were doubted of coronary heart disease and confirmed by coronary angiography were enrolled.According to the number of diseased coronary artery,they were divided into non-lesion group,single-vessel disease group,double-vessel disease group and multi-vessel disease group.Gensini’s score was calculated to assess the severity of coronary artery disease and HOMA-IR was calculated to assess the body＇s insulin resistance.Fasting plasma insulin（FINS）,fasting plasma glucose（FPG）,total cholesterol（TC）,triglyceride（TG）,high-density lipoprotein cholesterol（HDL）,low-density lipoprotein cholesterol（LDL）,apolipoprotein A（ApoA） and apolipoprotein B（ApoB）,2-hour postload plasma glucose（2hPPG） were measured.Results ①Gensini’s score was positively and significantly correlated with FPG,LDL,HbA1c and 2hPPG（P0.01）.Gensini’s score was positively correlated with age,ApoB and HOMA-IR（P0.05）.Gensini’s score was negatively and significantly correlated with DBP（P0.01）;②The number of diseased coronary artery was positively and significantly correlated with age,FPG,LDL,HbA1c and 2hPPG（P0.01）.The number of diseased coronary artery was positively correlated with UA,ApoB and HOMAIR（P0.05）;③Age was negatively and significantly correlated with DBP（correlation coefficient-0.224,P0.01）.Age was negatively correlated with ApoB（correlation coefficient-0.193,P0.05）;④ HOMA-IR was positively and significantly correlated with FPG,2hPPG,FINS,ApoB and HbA1c（P0.01）.HOMA-IR was positively correlated with LDL（P0.05）.After adjusting the influential factors such as sex,age,SBP,DBP,UA,TG,HDL,TC,LDL,ApoA and ApoB,HOMA-IR,FPG,HbA1c and 2hPPG were positively correlated with the number of diseased coronary artery and Gensini’s score（P0.05）.Conclusions Insulin resistance,HbA1c and high glucose were risk factors of coronary heart disease.They should be intervened earlier.