CAJ | 학술논문

目的　探讨胰岛素抵抗及其他危险因素与冠心病发病的关系. 方法　选择住院确诊的冠心病患者84例为病例组，排除冠心病的住院患者或健康体检者163例为对照组，对冠心病常见危险因素进行调查，检测空腹血糖、胰岛素水平、血脂、脂蛋白(a)等相关指标，用单因素和多因素分析计算危险因素的优势比（OR）及OR 95%可信限（95%CI），比较胰岛素水平和胰岛素敏感性等指标. 结果　病例组的空腹胰岛素水平显著高于对照组，胰岛素敏感性指数显著低于对照组(P<0.05)；其他危险因素的单因素分析显示，吸烟、高血压病史、高脂饮食习惯、冠心病家族史，脂蛋白（a）水平升高是冠心病的危险因素，其OR分别为2.49, 2.55, 3.23, 2.51和3.76，高密度脂蛋白水平是冠心病的保护因素，OR值为0.21；多因素分析结果显示，被筛选进入Logistic回归方程的变量分别为高密度脂蛋白、脂蛋白（a）、胆固醇水平和每日吸烟量. 结论　空腹胰岛素水平显著升高和(或)胰岛素敏感性降低与冠心病的发病有病因学联系(P<0.05)，吸烟、高血压病史、高脂饮食习惯、冠心病家族史、脂蛋白（a）水平升高是冠心病的危险因素，高密度脂蛋白水平是冠心病的保护因素.
목적　탐토이도소저항급기타위험인소여관심병발병적관계. 방 법　선택주원학진적관심병환자84례위병례조，배제관심병적주원환자혹건강체검자163례위대조조，대관심병상견위험인소진행조사，검측공복혈당、이도소수평、혈지、지단백(a)등상관지표，용단인소 화다인소분석계산위험인소적우세비（OR）급OR 95%가신한（95%CI），비교이도소수평화이도소민감성등지표. 결과　병례조적공복이도소수평현저고우대조조，이 도소민감성지수현저저우대조조(P<0.05)；기타위험인소적단인소분석현시，흡연、고혈압병사、고지음식 습관、관심병가족사，지단백（a）수평승고시관심병적위험인소，기OR분별위2.49, 2.55, 3.23, 2.51화3.76，고밀도지단백수평시관심병적보호인소，OR치위0.21；다인소분석결과현시， 피사선진입Logistic회귀방정적변량분별위고밀도지단백、지단백（a）、담고순수평화매일흡 연량. 결론　공복이도소수평현저승고화(혹)이도소민감성강저여관 심병적발병유병인학련계(P<0.05)，흡연、고혈압병사、고지음식습관、관심병가족사、지단백（a）수평승고 시관심병적위험인소，고밀도지단백수평시관심병적보호인소.
AIM　To investigate the relationship between insulin resistanc e and other risk factors and coronary heart disease (CHD). METHODS　Eighty-four CHD inpatien ts were selected as case group and 163 non-CHD persons from inpatients or healthy population were defined as control group. Major risk factors were investigated and variables such as serum glucose, insulin level, li pids and lipoprotein (a) were checked. Odds ratio (OR) and OR 95% confident interval were measured by uni -variable and multi-variable analysis. Means of insulin level and index of insulin sensitivit y were compared between two groups. RESULTS　Means of serum insulin level in cas es were significantly higher than those of controls, while index of insulin sensitivity was significantly low er than that of control group. Uni-variable analysis indicated that cigarette smoking, hypertension, fa t enriched diet, family history of CHD and elevated serum lipoprotein (a) were the risk factors of CHD, with ORs 2.49, 2.55, 3.23, 2.51 and 3.76 respectively. However, high density lipoprotein level was pr otective factor, with OR 0.21. Multi-variable analysis showed that cigarette smoking, serum levels of HDL-c, Lp(a), total cholesterol and consumption of cigarettes per-day were the variables being sele cted into logistic equation. CONCLUSION　Elevated serum insulin level and decreased index of insulin sensitivity is related to CHD. Cigarette smoking, hypertension , fat enriched diet, family histor y of CHD and elevated serum lipoprotein (a) are the risk factors of CHD. HDL-c level is a protective factor.