摘要
目的:探讨既往无糖尿病病史的急性心肌梗死患者早期胰岛素抵抗情况。方法:2009-02至2009-09,在我院连续入选158例既往无糖尿病病史,且在发病24 h内接受急诊经皮冠状动脉介入治疗的ST段抬高急性心肌梗死患者,出院前均进行口服葡萄糖耐量试验,按照结果分为糖代谢正常组(n=44)、糖调节受损组(n=65)和新诊断糖尿病组(n=49),以稳态模型胰岛素抵抗指数(HOMA-IR)≥2.5认为存在胰岛素抵抗,评价不同糖代谢组患者急性期(入院时)与稳定期(出院时)的胰岛素抵抗情况。结果:158例患者中,胰岛素抵抗者急性期为50.0%(79/158例),稳定期为31.6%(50/158例),胰岛素抵抗比例在急性期明显多于稳定期(P=0.000),差异有统计学意义。急性期HOMA-IR(0.98±0.81)明显高于稳定期HOMA-IR(0.58±0.67),P<0.05,差异有统计学意义。急性期HOMA-IR,新诊断糖尿病组高于糖调节受损组和糖代谢正常组[(1.30±0.84)vs(0.96±0.78)vs(0.57±0.55),P均<0.05],差异均有统计学意义。稳定期HOMA-IR新诊断糖尿病组和糖调节受损组高于糖代谢正常组[(0.78±0.57)vs(0.57±0.80)vs(0.41±0.51),P均<0.05],差异有统计学意义。多元逐步回归方程显示,第2天空腹血糖[标准化回归系数(β)=0.230,P=0.000]、空腹胰岛素(β=0.758,P=0.000)、体重指数(β=0.087,P=0.005)和糖化血红蛋白(β=0.104,P=0.003)是急性期胰岛素抵抗的影响因素;体重指数(β=0.382,P=0.000)是稳定期胰岛素抵抗的影响因素。结论:无论糖代谢情况如何,胰岛素抵抗在急性心肌梗死早期有加重现象;第2天空腹血糖、糖化血红蛋白和体重指数是急性期胰岛素抵抗的影响因素,体重指数是稳定期胰岛素抵抗的影响因素。
Objective ：To study the insulin resistance（IR） at the early stage in patients of acute myocardial infarction（AMI） without previous history of diabetes. Methods：We summarized 158 consecutive patients without previous history of diabetes from February to September 2009 in our hospital, all of them suffered from AMI and were admitted within 24 hours of onset. The patients received oral glucose tolerance test at admission（ acute stage）and discharge（ stable stage）, they were divided into three groups according to glucose metabolism condition as Normal group, n = 44, Damaged group, n = 65, and Diabetes group, n = 49, in which the patients with newly diagnosed diabetes. IR was defined as HOMA-IR ≥ 2. 5. We compared HOMA-IR level and calculated the independent predictors for HOMA-IR with multivariate regression analysis. Results ：There were 50. 0% （79/158）patients with IR at acute stage and 31.6% （50/158）at stable stage, IR ratio was higher in acute stage, P=0. 000. HOMA-IR was higher in acute stage than that in stable stage（0.98＋0. 81 ）vs. （0. 58±0. 67）,P〈0. 05. In acute stage, HOMA-IR level was as Diabetes group 〉 Damaged group 〉 Normal group as（ 1.30±0. 84）vs. （0. 96±0. 78 ） vs. （0. 57 ±0. 55 ）, P〈0. 05 respectively ; while in stable stage, HOMA-IR level as （0. 78±0. 57 ） vs. （ 0. 57 ±0. 80 ） vs. （0. 41 ±0. 51 ） , P〈0.05 respectively. Multivariate regression analysis showed that the 2nd day fasting glucose index （β=0. 230, P = 0. 000 ） , fasting insulin（β = 0. 758, P = 0. 000）, body mass index （β =0. 087, P = 0. 005 ） were the predictors of IR in acute stage; body mass index（β=0. 382, P=0. 000）was the risk factor of IR in stable stage. Conclusion： Insulin resistance is commonly increased at the early stage of AMI.
出处
《中国循环杂志》
CSCD
北大核心
2011年第5期339-342,共4页
Chinese Circulation Journal
基金
中华医学会心脑血管疾病血糖管理协作组(CGICC)基金资助项目(No.08010009)
关键词
心肌梗塞
葡萄糖耐量试验
胰岛素抵抗
Acute myocardial infarction
Oral glucose tolerance test
Insulin resistance
