摘要
目的探讨冠心病合并葡萄糖耐量受损(IGT)患者胰岛素抵抗(IR)与冠状动脉病变程度之间的关系。方法 152例冠心病并IGT患者及35例冠心病非IGT患者(对照组),采用HOMA2法测定IR指数(HOMA2-IR),采用Gensini积分系统定量评定冠状动脉狭窄程度,B2/C型病变定义为冠状动脉形态学复杂病变。以HOMA2-IR四分位数为切点将冠心病并IGT患者分为4组:第1四分位数组(n=38)、第2四分位数组(n=38)、第3四分位数组(n=38)、第4四分位数组(n=38),比较5组基线资料及冠状动脉造影结果。结果 5组间餐后2 h血糖(2h PBG)、糖化血红蛋白(Hb A1c)、空腹胰岛素和Gensini积分逐渐增高,差异有统计学意义(P<0.01)。第4四分位数组多支病变和B2/C病变明显高于第1四分位数组和对照组(P<0.05)。相关性分析显示,Gensini积分与HOMA2-IR(r=0.712,P<0.001)存在较强的正相关。多元逐步回归分析显示,HOMA2-IR、Hb A1c和2h PBG是影响冠状动脉狭窄程度的独立危险因素。Logistic回归分析显示,HOMA2-IR是多支病变和B2/C病变的独立危险因素。结论IR是反映冠心病并IGT患者冠状动脉狭窄程度的重要指标。
Aim To investigate the correlation between insulin resistance（ IR） and degree of coronary artery lesion in patients with coronary heart disease（ CHD） and impaired glucose tolerance（ IGT）. Methods 152 CHD patients with IGT,and 35 CHD patients with non-IGT（ control group） were enrolled in this study. IR index（ HOMA2-IR）was determined by HOMA2 method. Gensini score system was used to assess the degree of coronary artery stenosis quantitatively,and the type B2/ C lesions were defined as complex lesions of the coronary artery. Taking the HOMA2-IR quartile as the cutoff point,152 CHD patients with IGT were divided into 4 groups： the first quartile group（ n = 38）,the second quartile group（ n = 38）,the third quartile group（ n = 38）,the fourth quartile group（ n = 38）. Baseline data and the results of coronary angiography were compared among the five groups. Results 2 hour postprandial blood glucose（ 2h PBG）,glycosylated hemoglobin A1（ Hb A1c）,fasting insulin and Gensini score increased gradually in the 5 groups,the difference was statistically significant（ P〈0.01）. Coronary multiple lesions and B2/ C lesions in fourth quartile group were significantly higher than those in first quartile group and control group（ P〈0.05）. Correlation analysis showed that Gensini score was positively correlated with HOMA2-IR（ r = 0.712,P〈0.001）. Multivariable stepwise regression analysis showed that HOMA2-IR,HbA 1c and 2hP BG were the independent risk factors affecting the degree of coronary artery stenosis. Logistic regression analysis showed that HOMA2-IR was an independent risk factor for multiple lesions and B2/ C lesions. Conclusion IR is an important index reflecting the degree of coronary artery stenosis in patients with CHD and IGT.
出处
《中国动脉硬化杂志》
CAS
北大核心
2017年第1期48-52,共5页
Chinese Journal of Arteriosclerosis
基金
洛阳市科技攻关项目(1201050A-1)
关键词
冠心病
糖耐量受损
胰岛素抵抗
冠状动脉病变程度
Coronary heart disease
Impaired glucose tolerance
Insulin resistance
Degree of coronary artery lesion
