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目的危重症患儿多伴明显的胰岛素抵抗和心肌损害。本研究探讨危重症患儿胰岛素抵抗与心肌损害的关系。方法选取2010年3月至2011年6月住院治疗的危重症患儿63例为病例组,测定空腹血糖、血清胰岛素及心肌酶、肌钙蛋白I(CTnI)水平,同时计算胰岛素抵抗指数(HOMA-IR)。HOMA-IR>1.0者归入胰岛素抵抗组(30例),HOMA-IR≤1.0者归入非胰岛素抵抗组(33例)。同时选取健康儿童30例作为对照组。结果胰岛素抵抗组患儿的HOMA-IR、乳酸脱氢酶(LDH)、天门冬氨酸氨基转移酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(α-HBDH)、CTnI水平均明显高于非胰岛素抵抗组及对照组,差异有统计学意义(均P<0.05);非胰岛素抵抗组患儿的LDH、AST、CK、CK-MB、α-HBDH、CTnI水平明显高于对照组,差异有统计学意义(均P<0.05)。胰岛素抵抗组患儿的HOMA-IR与LDH、CK、CK-MB、AST、α-HBDH、CTnI水平呈正相关(分别r=0.697,0.739,0.781,0.642,0.381,0.792,均P<0.05)。结论胰岛素抵抗可以加重心肌损害,HOMA-IR可以作为心肌损害程度的预测指标。
Purpose of critically ill children often accompanied by significant insulin resistance and myocardial damage. This study was to investigate the relationship between insulin resistance and myocardial damage in critically ill children. Methods Sixty-three cases of critically ill children hospitalized from March 2010 to June 2011 were selected as the case group. Fasting blood glucose, serum insulin and myocardial enzyme, troponin I (CTnI) levels were measured. Meanwhile, insulin resistance index (HOMA -IR). HOMA-IR> 1.0 were classified as insulin resistance group (30 cases), HOMA-IR≤1.0 were classified as non-insulin resistance group (33 cases). At the same time, 30 healthy children were selected as the control group. Results HOMA-IR, LDH, AST, CK, CK-MB, α (-HPDH) and CTnI were significantly higher in non-insulin resistance group than in non-insulin resistance group and control group (all P <0.05). LDH, AST, The levels of CK, CK-MB, α-HBDH and CTnI were significantly higher than those of the control group (all P <0.05). There was a positive correlation between HOMA-IR and LDH, CK, CK-MB, AST, α-HBDH and CTnI in children with insulin resistance (r = 0.697,0.739,0.781,0.642,0.381,0.792, all P <0.05). Conclusion Insulin resistance can aggravate myocardial damage, HOMA-IR can be used as a predictor of myocardial damage.