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目的:探讨冠心病患者胰岛素敏感性和血脂水平与冠状动脉病变范围及程度的关系。方法:检测100例冠状动脉造影阳性患者(冠心病组)、50例冠状动脉造影阴性患者(阴性组)和50例健康者(对照组)的空腹血脂、血糖、胰岛素浓度及胰岛素敏感性指标。分别以冠状动脉狭窄分数和病变冠状动脉支数为因变量,血脂、血糖、胰岛素和胰岛素敏感性指标为自变量,进行单元直线相关分析和多元逐步回归分析。结果:冠心病组与对照组除总胆固醇、血糖外,血脂、胰岛素和胰岛素敏感性差异均有统计学意义(P<0.05);冠心病组仅有高密度脂蛋白和胰岛素敏感性指数明显低于阴性组(P<0.05)。冠心病组胰岛素和胰岛素敏感性指数与冠状动脉狭窄分数显著相关(r=0.25,P<0.05;r=-0.32,P<0.01),病变冠状动脉支数与任何自变量无相关性。逐步回归分析显示,胰岛素敏感性指数与冠状动脉病变程度独立相关。结论:冠心病存在胰岛素抵抗、高胰岛素血症和血脂尤其是高密度脂蛋白异常,均为冠心病发病危险因素;胰岛素敏感性指数是影响冠状动脉病变程度独立影响因子。
Objective: To investigate the relationship between insulin sensitivity and serum lipids and the extent and severity of coronary artery disease in patients with coronary heart disease. Methods: Fasting blood lipids, blood glucose, insulin and insulin sensitivity were measured in 100 patients with positive coronary angiography (coronary heart disease), 50 patients with negative coronary angiography (negative) and 50 healthy controls (control group). Linear regression analysis and multivariate stepwise regression analysis were performed using coronary stenosis score and coronary artery count as the dependent variable, blood lipid, glucose, insulin and insulin sensitivity as independent variables. Results: In addition to the total cholesterol and blood glucose, there was significant difference between the CHD group and the control group in blood lipid, insulin and insulin sensitivity (P <0.05). Only the HDL and insulin sensitivity index of CHD group were significantly lower In the negative group (P <0.05). The indexes of insulin sensitivity and insulin sensitivity in coronary heart disease group were significantly correlated with coronary artery stenosis score (r = 0.25, P <0.05; r = -0.32, P <0.01). There was no correlation between coronary artery branch number and any independent variables. Stepwise regression analysis showed that the insulin sensitivity index was independently associated with the degree of coronary artery disease. Conclusion: There is insulin resistance, hyperinsulinemia and hyperlipidemia in coronary heart disease, all of which are risk factors for coronary heart disease. Insulin sensitivity index is an independent factor influencing the severity of coronary artery disease.