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目的探讨危重症患儿应激状态下胰岛素抵抗对心肌的损伤作用。方法根据胰岛素抵抗指数(HOMAIR),将115例危重症患儿分为胰岛素抵抗组(57例)和非胰岛素抵抗组(58例),同期选择50名健康儿童作为对照组。所有研究对象均检测胰岛素水平、血糖、心肌酶和心肌肌钙蛋白I(cTnI)。结果三组研究对象的心肌酶指标和cTnI均差异明显(P<0.05),其中胰岛素抵抗组HOMA-IR、心肌酶指标和cTnI均显著高于胰岛素非抵抗组与对照组(P<0.05)。相关性分析显示,胰岛素抵抗组的HOMA-IR与心肌酶、CTnI水平均呈正相关(LDH:r=0.684;AST:r=0.638;CK:r=0.725;CK-MB:r=0.775;α-HBOH:r=0.378;CTnI:r=0.831),其中HOMA-IR与CTnI的相关性最密切。结论危重症患儿胰岛素抵抗对心肌有损伤作用,应注意给予心肌保护治疗。
Objective To investigate the effect of insulin resistance on myocardial injury in critically ill children under stress. Methods According to the insulin resistance index (HOMAIR), 115 children with critical illness were divided into insulin resistance group (57 cases) and non-insulin resistance group (58 cases). 50 healthy children were selected as the control group. All subjects examined insulin levels, glucose, myocardial enzymes, and cardiac troponin I (cTnI). Results The indexes of myocardial enzymes and cTnI in the three groups were significantly different (P <0.05). The levels of HOMA-IR, myocardial enzymes and cTnI in insulin resistance group were significantly higher than those in non-insulin group and control group (P <0.05). Correlation analysis showed that there was a positive correlation between HOMA-IR and myocardial enzymes and CTnI in insulin resistance group (LDH: r = 0.684; AST: r = 0.638; CK: r = 0.725; HBOH: r = 0.378; CTnI: r = 0.831), of which HOMA-IR was most closely related to CTnI. Conclusion Insulin resistance in critically ill children has the effect of myocardial injury, should pay attention to myocardial protection therapy.