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目的:研究急性冠脉综合征(ACS)患者负荷后2小时血糖和胰岛素抵抗与冠状动脉病变严重程度的关系。方法:入选88例ACS患者,男性60例,女性28例,均行冠状动脉造影检查。病情平稳后行75g葡萄糖负荷试验和胰岛素释放试验,分为血糖正常组(n=28)、糖调节异常组(n=37)、糖尿病组(n=23),比较各组冠状动脉病变积分,并分析冠状动脉积分与负荷后2小时血糖水平、胰岛素抵抗的相关性。结果:①血糖正常组、糖调节异常组和糖尿病组冠状动脉积分,差异有统计学意义(P<0.01)。与血糖正常组比,糖调节异常组和糖尿病组空腹胰岛素水平均升高(P<0.01)。②88例患者冠状动脉积分与负荷后2小时血糖呈正相关(r=0.486,P<0.01),与空腹血糖呈正相关(r=0.308,P<0.01)。冠状动脉积分与胰岛素抵抗指数呈正相关(r=0.217,P<0.05)。多元线性回归分析显示负荷后2小时血糖和负荷后2小时胰岛素水平与冠状动脉积分呈正相关(偏相关系数分别为1.392,0.073,P<0.01)。结论:ACS患者负荷后2小时血糖与ACS患者冠状动脉粥样硬化程度有关,餐后血糖越高冠状动脉损害越明显,胰岛素抵抗是其共同的基础。
Objective: To study the relationship between the severity of coronary artery disease and the level of blood glucose and insulin resistance 2 hours after loading in patients with acute coronary syndrome (ACS). Methods: Eighty-eight patients with ACS were enrolled. There were 60 males and 28 females. Coronary angiography was performed. The patients were divided into two groups: normal blood glucose group (n = 28), abnormal glucose regulation group (n = 37) and diabetic group (n = 23) after 75g glucose load test and insulin release test. And analyze the relationship between coronary artery integral and blood glucose level and insulin resistance 2 hours after the load. Results ① There was a significant difference in coronary artery scores between normal glucose group, abnormal glucose regulation group and diabetic group (P <0.01). Compared with the normal blood glucose group, the fasting insulin levels in the abnormal glucose-regulated group and diabetic group were significantly increased (P <0.01). (2) There was a positive correlation between coronary artery score and blood glucose level at 2 hours after loading in 88 patients (r = 0.486, P <0.01), and positively correlated with fasting blood glucose (r = 0.308, P <0.01). Coronary artery scores were positively correlated with insulin resistance index (r = 0.217, P <0.05). Multivariate linear regression analysis showed that there was a positive correlation between the level of insulin and the level of coronary artery 2 hours after 2 hours of loading (P <0.01). Conclusion: The blood glucose level of ACS patients at 2 hours after loading is related to the degree of coronary atherosclerosis in patients with ACS. The higher the postprandial blood glucose is, the more obvious is the damage of coronary artery. Insulin resistance is the common basis.