中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2009年
5期
475-477
,共3页
赵良平%吕安康%刘海峰%张奇%丁风华%张瑞岩%胡健%蔡煦%张建盛%沈卫峰
趙良平%呂安康%劉海峰%張奇%丁風華%張瑞巖%鬍健%蔡煦%張建盛%瀋衛峰
조량평%려안강%류해봉%장기%정풍화%장서암%호건%채후%장건성%침위봉
胰岛素抵抗%急性ST段抬高型心肌梗死%血流再通
胰島素牴抗%急性ST段抬高型心肌梗死%血流再通
이도소저항%급성ST단태고형심기경사%혈류재통
Insulin resistance%Acute ST-elevation myocardial infarction%Recanalizafion
目的 探讨糖耐量正常且伴发急性ST段抬高型心肌梗死患者胰岛素抵抗与梗死相关动脉早期血流自发再通的关系.方法 连续入选141例糖耐量正常且伴发急性ST段抬高型心肌梗死患者,根据急诊冠状动脉造影结果 分为TIMI 0～1级组(91例)和,TIMI 2～3级组(50例).计算病变支数和Gensini得分,测定代谢参数和hs-CRP,计算胰岛素抵抗指数(IRI),进行相关统计分析.结果 血流TIMI 0～1级组的空腹胰岛素[(11.52±6.22)mU/L]、IRI(2.79±2.32)和Gensini得分[(59.17±26.95)分]显著高于TIMI2～3级组[(7.54±3.65)mU/L、(1.73±1.26)和(38.46±22.74)分](P均<0.01).IRI和Gensini得分呈显著正相关(r=0.185,P<0.05).Logistic回归分析提示,IRI是影响梗死相关动脉血流自发再通的独立危险因素(OR=2.87,95%CI为1.09～7.57,P<0.05).结论 胰岛素抵抗是影响搪耐量正常且伴发急性ST段抬高型心肌梗死患者梗死相关动脉早期血流自发再通的独立危险因素.
目的 探討糖耐量正常且伴髮急性ST段抬高型心肌梗死患者胰島素牴抗與梗死相關動脈早期血流自髮再通的關繫.方法 連續入選141例糖耐量正常且伴髮急性ST段抬高型心肌梗死患者,根據急診冠狀動脈造影結果 分為TIMI 0～1級組(91例)和,TIMI 2～3級組(50例).計算病變支數和Gensini得分,測定代謝參數和hs-CRP,計算胰島素牴抗指數(IRI),進行相關統計分析.結果 血流TIMI 0～1級組的空腹胰島素[(11.52±6.22)mU/L]、IRI(2.79±2.32)和Gensini得分[(59.17±26.95)分]顯著高于TIMI2～3級組[(7.54±3.65)mU/L、(1.73±1.26)和(38.46±22.74)分](P均<0.01).IRI和Gensini得分呈顯著正相關(r=0.185,P<0.05).Logistic迴歸分析提示,IRI是影響梗死相關動脈血流自髮再通的獨立危險因素(OR=2.87,95%CI為1.09～7.57,P<0.05).結論 胰島素牴抗是影響搪耐量正常且伴髮急性ST段抬高型心肌梗死患者梗死相關動脈早期血流自髮再通的獨立危險因素.
목적 탐토당내량정상차반발급성ST단태고형심기경사환자이도소저항여경사상관동맥조기혈류자발재통적관계.방법 련속입선141례당내량정상차반발급성ST단태고형심기경사환자,근거급진관상동맥조영결과 분위TIMI 0～1급조(91례)화,TIMI 2～3급조(50례).계산병변지수화Gensini득분,측정대사삼수화hs-CRP,계산이도소저항지수(IRI),진행상관통계분석.결과 혈류TIMI 0～1급조적공복이도소[(11.52±6.22)mU/L]、IRI(2.79±2.32)화Gensini득분[(59.17±26.95)분]현저고우TIMI2～3급조[(7.54±3.65)mU/L、(1.73±1.26)화(38.46±22.74)분](P균<0.01).IRI화Gensini득분정현저정상관(r=0.185,P<0.05).Logistic회귀분석제시,IRI시영향경사상관동맥혈류자발재통적독립위험인소(OR=2.87,95%CI위1.09～7.57,P<0.05).결론 이도소저항시영향당내량정상차반발급성ST단태고형심기경사환자경사상관동맥조기혈류자발재통적독립위험인소.
Objective To clarify the role of insulin resistance on spontaneous recanalization of infarct-relat-ed arteries in the early phase of acute ST-elevation myocardial infarction (STEMI) in patients with normal glucose tolerance. Methods 141 consecutive patients with normal glucose tolerance and acute STEMI were enrolled in our study. Subjects were divided into TIMI 0-1 group (n =91 ) and TIMI 2-3 group (n =50) by primary coronary angi-ngraphy (CAG). The Gemini score and 0-3-vessel disease score estimated the severity and extent of coronary artery disease (CAD). Metabolic parameters and homeostasis model assessment for insulin resistance (IRI) were deter-mined. Results Serum level of fasting insulin, IRI and Gemini score were higher in TIMI 0-1 group than in TIMI 2-3 group [ (11.52±6.22)mU/L vs (7.54±3.65)mU/l,(2.79±2.32) vs (1.73±1.26),(59.17±26.95) vs ( 38.46±22.74) ( P <0.01)]. IRI was positively associated with Gemini score (r=0.185,P <0.05 ). Multivariate Logistic regression analysis revealed that IRI was independent risk factor influencing spontaneous recanalization of in-farct-related urteries(OR=2.87,95% CI=1.09-7.57,P<0.05). Conclusion Insulin resistance is independent risk factor influencing spontaneous recanalizafion of infarct-related arteries in the early phase of acute STEMI in pa-tients with normal glucose tolerance.
