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目的:探讨冠心病伴胰岛素抵抗(IR)患者血脂、纤维蛋白原(FIB)、血小板聚集率(PAGM)之间的相关性并与单纯冠心病患者进行比较。方法:将糖耐量正常的118例冠心病患者,根据空腹胰岛素(FINS)>25 mU/L或餐后胰岛素(PINS)/餐后2 h血糖(2hPG)>0.5 mg/dl为胰岛素抵抗组(IR组)76例;低于此值为非胰岛素抵抗组(non-IR组)42例。检测其空腹血糖(FPG)、FINS、2hPG、PINS、FIB、PAGM并且计算胰岛素抵抗指数(HOMA-IR)两组进行比较。结果:IR组高血压发病率、TG明显高于non-IR组,高密度脂蛋白-C(HDL-C)明显降低(P<0.05),IR组FINS、PINS、HOMA-IR、FIB、PAGM较non-IR组明显升高(P<0.01),HOMA-IR与TG、FIB、PAGM呈正相关(r=0.52、0.58、0.55,P<0.01)与HDL-C呈负相关(r=-0.48,P<0.01)。结论:表明冠心病伴IR患者除血糖外与糖尿病患者拥有相似的生化特征,IR似处于核心地位,是多种代谢异常和心血管疾病的致病基础。检测INS、FIB、PAGM对急性冠脉事件的近期、预后有较强的预测价值。
Objective: To investigate the correlation between serum lipids, fibrinogen (FIB) and platelet aggregation rate (PAGM) in patients with coronary heart disease and insulin resistance (IR) and to compare with patients with simple coronary heart disease. Methods: 118 patients with normal glucose tolerance were divided into three groups according to insulin resistance (FINS> 25 mU / L or postprandial insulin (PINS) / 2 hPG> 0.5 mg / dl) IR group) 76 cases; below this value for the non-insulin resistance group (non-IR group) 42 cases. The fasting blood glucose (FPG), FINS, 2hPG, PINS, FIB, PAGM and HOMA-IR were calculated and compared. Results: The incidence of hypertension in TG group was significantly higher than that in non-IR group (P <0.05). The levels of FINS, PINS, HOMA-IR, FIB, PAGM HOMA-IR was positively correlated with TG, FIB and PAGM (r = 0.52,0.58,0.55, P <0.01), but negatively correlated with HDL-C (r = -0.48 , P <0.01). CONCLUSIONS: Coronary heart disease patients with IR have similar biochemical characteristics to those with diabetes mellitus except for blood glucose. IR seems to be at the core and is the causative agent of a variety of metabolic disorders and cardiovascular diseases. The detection of INS, FIB, PAGM has a strong predictive value for the recent and prognosis of acute coronary events.