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目的探讨稳定型心绞痛患者中胰岛素抵抗(IR)程度与冠状动脉病变的关系。方法选取拟诊为稳定型心绞痛入院行冠状动脉造影的患者272例,男199例,女73例,平均年龄为(59±8)岁,糖尿病患者除外,测定空腹血胰岛素、血脂、血糖等生化指标。采用McAuley指数评价IR程度,根据冠状动脉病变积分评价冠状动脉病变程度。结果 272例患者中,有IR者85例(31.35%);冠状动脉未见粥样硬化改变76例(27.9%),冠状动脉有粥样斑块但狭窄程度<50%78例(28.7%),冠状动脉狭窄≥50%118例(43.4%)。McAuley指数与冠状动脉病变积分呈负相关(r=-0.153,P<0.05),空腹血胰岛素水平与冠状动脉病变积分不相关(P>0.05)。采用K-means聚类法将不同冠状动脉病变积分的患者分为组A(冠状动脉病变积分<1.9分)、组B(冠状动脉病变积分为1.9～4.83分)和组C(冠状动脉病变积分≥4.84分)。与组A比较,组C的McAuley指数显著降低(P<0.05)。3组间空腹血胰岛素水平的差异无统计学意义(P>0.05)。结论 IR程度与冠状动脉造影评价的病变严重程度呈正相关,空腹胰岛素水平与冠状动脉造影评价的病变程度不相关。
Objective To investigate the relationship between insulin resistance (IR) and coronary artery disease in patients with stable angina pectoris. Methods A total of 272 patients with coronary angiography who were admitted to stable angina pectoris were enrolled in the study. There were 199 males and 73 females, with an average age of (59 ± 8) years. Except diabetics, fasting blood insulin, lipids and blood glucose index. The McAuley index was used to evaluate the degree of IR and the degree of coronary artery disease was evaluated according to the coronary artery disease score. Results There were 85 patients (31.35%) with IR in 272 patients, 76 patients (27.9%) with coronary atherosclerosis, 78 patients (28.7%) with atherosclerotic plaque but less than 50% , Coronary stenosis ≥ 50% 118 cases (43.4%). The McAuley index was negatively correlated with coronary artery disease score (r = -0.153, P <0.05). Fasting plasma insulin level was not correlated with coronary artery disease score (P> 0.05). Patients with different coronary artery disease scores were divided into group A (coronary artery disease score <1.9), group B (coronary artery disease score 1.9 to 4.83) and group C (coronary artery disease score) using K-means clustering method. ≥4.84 points). Compared with group A, the McAuley index of group C was significantly lower (P <0.05). There was no significant difference in fasting blood insulin between the three groups (P> 0.05). Conclusion The degree of IR is positively correlated with the severity of the lesion evaluated by coronary angiography. The level of fasting insulin is not correlated with the severity of coronary angiography.