CAJ | 학술논문

目的探讨胰岛素抵抗(IR)、血压变异性(BPV)与急性冠状动脉(冠脉)综合征(ACS)患者冠脉病变严重程度的关系及对患者经皮冠脉介入治疗(PCI)后近期预后的影响.方法选择2009年12月至2010年12月诊断为ACS的患者260例,其中不稳定性心绞痛93例,非ST段抬高心肌梗死84例,ST段抬高心肌梗死83例.以入选患者24 h收缩压变异系数(CV) 11.5为界,分为低CV组(24 h收缩压CV＜11.5)130例和高CV组(24 h收缩压CV ＞11.5)130例.比较2组患者稳态模型法评估的胰岛素抵抗指数(HOMA-IR)及冠脉病变严重程度的差异,并观察胰岛素抵抗(IR)及BPV与接受PCI治疗的ACS患者6个月主要心脏不良事件发生的关系.结果高CV组ACS患者HOMA-IR明显高于低CV组(5.7±1.2比4.0±1.4,P＜O.01),并且冠脉多支病变率、B2/C型病变率及冠脉病变狭窄程度( Gensini)积分均高于低CV组患(49.2％比33.3％,P＜0.05；48.5％比27.7％；59.7 ±17.5比43.8±18.6,P值均＜0.01).多因素logistic回归分析显示,IR、24 h收缩压CV均是ACS患者PCI术后6个月内主要心脏不良事件发生的独立预测因子(P＜0.05或＜0.01).结论 IR和BPV与ACS患者冠脉病变严重程度明显相关,IR与24 h收缩压CV对患者的近期预后具有预测意义.
목적 탐토이도소저항(IR)、혈압변이성(BPV)여급성관상동맥(관맥)종합정(ACS)환자관맥병변엄중정도적관계급대환자경피관맥개입치료(PCI)후근기예후적영향.방법 선택2009년12월지2010년12월진단위ACS적환자260례,기중불은정성심교통93례,비ST단태고심기경사84례,ST단태고심기경사83례.이입선환자24 h수축압변이계수(CV) 11.5위계,분위저CV조(24 h수축압CV＜11.5)130례화고CV조(24 h수축압CV ＞11.5)130례.비교2조환자은태모형법평고적이도소저항지수(HOMA-IR)급관맥병변엄중정도적차이,병관찰이도소저항(IR)급BPV여접수PCI치료적ACS환자6개월주요심장불량사건발생적관계.결과 고CV조ACS환자HOMA-IR명현고우저CV조(5.7±1.2비4.0±1.4,P＜O.01),병차관맥다지병변솔、B2/C형병변솔급관맥병변협착정도( Gensini)적분균고우저CV조환(49.2％비33.3％,P＜0.05；48.5％비27.7％；59.7 ±17.5비43.8±18.6,P치균＜0.01).다인소logistic회귀분석현시,IR、24 h수축압CV균시ACS환자PCI술후6개월내주요심장불량사건발생적독립예측인자(P＜0.05혹＜0.01).결론 IR화BPV여ACS환자관맥병변엄중정도명현상관,IR여24 h수축압CV대환자적근기예후구유예측의의.
Objective To investigate the association of insulin resistance (IR),blood pressure variability (BPV) and the severity of acute coronary syndrome (ACS),and assess the effect of percutaneous coronary intervention (PCI) on recent prognosis.Methods A total of 260 patients diagnosed as ACS and hospitalized in our department of cardiology from December 2009 to December 2010 were enrolled in the study.There were 93 cases of unstable angina pectoris ( UAP),84 of non ST segment elevation myocardial infarction and 83 of unstable angina pectoris.The subjects were divided into two groups according to 24 hour systolic blood pressure coefficient of variability (24 h SBP-CV) levels:high-CV group (24 h SBP-CV ＞11.5,n =130) and low-CV group(24 h SBP-CV ＜ 11.5,n =130).The differences in HOMA-IR and the severity of coronary artery diseases between the two groups were compared.The association of major adverse cardiac events within 6 months after PCI treatment,and IR as well as BPV was analyzed.Results Compared with the low-CV group,ACS patients in the high-CV group had obviously higher HOMA-IR levels (5.7 ± 1.2 vs 4.0 ± 1.4,P ＜0.01 ),more multivessel diseases (49.2％ vs 33.3％,P ＜0.05) and B2/C type coronary diseases (48.5％ vs 27.7％,P ＜0.01 ),and higher coronary Gensini scores (59.7 ± 17.5vs 43.8 ± 18.6,P ＜ 0.01 ).Multi-factors logistic regression analysis indicated that both 24 h BPV-CV and IR were independent predictors for MACE incidence within 6 months after undergone PCI ( P ＜ 0.05 or P ＜0.01 ).Conclusions IR and BPV were obviously associated with the severity of coronary artery diseases in ACS patients.IR and 24 h BPV-CV were valuable in predicting recent prognosis of ACS patients.