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目的:探讨非糖尿病患者胰岛素抵抗(IR)、高敏C反应蛋白(hsCRP)在冠心病发病中的作用。方法:将连续608例非糖尿病患者,根据冠脉造影结果分为冠心病组(334例)和对照组(274例)。测定代谢参数和hsCRP,并用自我平衡模型分析法(HOMA)指数(IRI)评价胰岛素抵抗,进行相关数理统计。结果:冠心病组的年龄、空腹血浆胰岛素、平均IRI、hsCRP、脂蛋白a、血肌酐、血清肌酐清除率、左心室射血分数、高血压、男性、吸烟、IRI≥2.69以及既往血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)应用比例均显著高于对照组,差异有统计学意义(P<0.05～0.01),高密度脂蛋白显著低于对照组,差异有统计学意义(P<0.01)。多因素Logistic回归分析提示,男性、高龄(≥65岁)、IRI≥2.69、hsCRP≥10 mg/L、脂蛋白a≥0.22 g/L和血肌酐≥100umol/L,为冠心病独立危险因素(P均<0.05)。综合各种危险因素的受试者工作曲线(ROC)下面积为0.750(P<0.01);hsCRP的ROC曲线下面积为0.685(P<0.01)。IRI与冠心病发生呈显著正相关(P<0.01)。结论:即使非糖尿病患者,胰岛素抵抗和hsCRP升高等仍为冠心病的独立危险因素。
Objective: To investigate the role of insulin resistance (IR) and high-sensitivity C-reactive protein (hsCRP) in the pathogenesis of coronary heart disease in non-diabetic patients. Methods: A total of 608 non-diabetic patients were divided into coronary heart disease group (334 cases) and control group (274 cases) according to coronary angiography results. Metabolic parameters and hsCRP were measured, and insulin resistance was evaluated by HOMA index (IRI), and related mathematical statistics were performed. Results: The age, fasting plasma insulin, mean IRI, hsCRP, lipoprotein a, serum creatinine, serum creatinine clearance, left ventricular ejection fraction, hypertension, male, smoking, IRI≥2.69 and previous angiotensin The ratio of ACEI or ARB was significantly higher than that of the control group (P <0.05 ~ 0.01), HDL was significantly lower than that of the control group, The difference was statistically significant (P <0.01). Multivariate logistic regression analysis showed that male, elderly (≥65 years), IRI≥2.69, hsCRP≥10 mg / L, lipoprotein a≥0.22 g / L and serum creatinine≥100umol / L were independent risk factors for CHD P <0.05). The area under the receiver operating curve (ROC) for all risk factors was 0.750 (P <0.01), and the area under the ROC curve for hsCRP was 0.685 (P <0.01). There was a significant positive correlation between IRI and coronary heart disease (P <0.01). Conclusion: Even non-diabetic patients, insulin resistance and elevated hsCRP are still independent risk factors for coronary heart disease.