胰島素抵抗與急性心梗患者預(yù)后的關(guān)系
發(fā)布時(shí)間：2018-07-14 11:12
【摘要】：目的:探討胰島素抵抗在接受直接皮冠狀動(dòng)脈介入治療的急性心�；颊咧械呐R床分布特征,了解胰島素抵抗與急性心�；颊吖跔顒�(dòng)脈病變的關(guān)系,通過隨訪1年內(nèi)MACCE事件發(fā)生率了解胰島素抵抗與心�；颊咴簝�(nèi)、院外預(yù)后的相關(guān)性。方法:收集年月至年月在天津市泰達(dá)國際心血管病醫(yī)院急診就診的符合入選標(biāo)準(zhǔn)的接受直接皮冠脈介入治療的急性心梗患者202例作為入選對(duì)象。采用穩(wěn)態(tài)模型胰島素抵抗指數(shù)(Homeostasis model assessment of insulin resistance HOMA-IR)評(píng)價(jià)胰島素抵抗,即IRI=[空腹血糖(mmol/L)×空腹胰島素(U/L)]÷22.5,以IRI≥2.69定義為胰島素抵抗,IRI2.69為胰島素敏感。按照胰島素抵抗指數(shù)將觀察對(duì)象分為胰島素抵抗組和敏感組,應(yīng)用四分位數(shù)法將胰島素抵抗患者分為輕、中、重、極重度四組。記錄所有患者的性別、年齡、體重、身高、高血壓史、糖尿病史、吸煙史,并檢測(cè)其甘油三酯(triglyceride TG)、總膽固醇(total cholesterol TC)、低密度脂蛋白(low-density lipoprotein LDL)、高密度脂蛋白(high density lipoprotein HDL)、超敏C-反應(yīng)蛋白(High-sensitivity C-reactive protein hs-CRP)、同型半胱氨酸(homocysteinemia HCY)、空腹血糖(fasting plasma glucose FPG)、空腹胰島素(Fasting serum insulin FINS)、肌酐(creatinite CR)、尿酸(uric acid UC)水平。根據(jù)冠脈造影,通過SYNTAX積分評(píng)價(jià)冠脈病變嚴(yán)重程度;罪犯血管及冠脈病變支數(shù)了解冠脈病變范圍;支架長度及直徑推斷冠脈病變類型,分析胰島素抵抗與以上冠脈病變因素的相關(guān)性。記錄急性心�；颊咦笮氖�(left ventricle LV)內(nèi)徑大小及左室射血分?jǐn)?shù)(left ventricle ejection fraction LVEF)進(jìn)而評(píng)估心功能情況。隨訪心�；颊呓槿胫委熜g(shù)后1年內(nèi)MACCE(全因死亡、再發(fā)心梗、需住院治療的心衰、心絞痛、卒中、支架血栓等)事件發(fā)生率,應(yīng)用ROC曲線評(píng)價(jià)胰島素抵抗對(duì)MACCE事件的預(yù)測(cè)價(jià)值。結(jié)果:.胰島素抵抗組例,男例,年齡歲,平均()歲,敏感組96例,男74例,年齡35-83歲,平均(61±12)歲;胰島素抵抗亞組中,輕度抵抗組26例,男性16例,年齡35-80歲,平均(63±10)歲,中度抵抗組27例,男性例,年齡歲,平均()歲,重度抵抗組例,男性例,年齡歲,平均()歲,極重度抵抗組例,男性例,年齡43-82歲,平均(63±7)歲。2.胰島素抵抗組高血壓患病率(66.98%)、糖尿病患病率(33.02%)、BMI(25.37±2.44/kg/m2)、TG(2.31±3.42/mmol/L)、CR(75.87±23.53/umol/L)、CRP(23.33±31.00/mg/L)、FPG(8.70±3.55/mmol/L)、FINS(17.37±11.89/U/L)明顯高于敏感患者,且差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。胰島素抵抗亞組分析中,極重度抵抗組BMI(26.46±2.01/kg/m2)、CRP(36.62±41.88/mg/L)較輕度、中度組明顯升高,TG(4.11±6.33/mmol/L)、FPG(11.20±5.25/mmol/L)、FINS(31.17±16.36/U/L)較輕、中、重度抵抗組亦明顯升高,差異均具有統(tǒng)計(jì)學(xué)意義(p0.05)。胰島素抵抗組與敏感組、胰島素抵抗亞組中患者的年齡、性別、吸煙史、TC、LDL、HDL、HCY、UC水平均無統(tǒng)計(jì)學(xué)差異(p0.05)。3.胰島素抵抗組SYNTAX積分(19.00±8.65)、支架長度(36.18±19.62/mm)、多支病變比例(75.47%)明顯高于敏感組,支架直徑(2.98±0.45/mm)明顯小于敏感(3.45±2.29/mm)組,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。SYNTAX積分在極重度抵抗組(23.56±8.27)較輕度(16.48±8.23)、中度(17.15±7.42)、重度(18.89±9.24)組明顯升高,且具有統(tǒng)計(jì)學(xué)差異(p0.05)。在胰島素抵抗亞組分析中支架長度、直徑、冠脈病變支數(shù)、冠脈病變部位均無統(tǒng)計(jì)學(xué)差異(p0.05)。4.胰島素抵抗組左室射血分?jǐn)?shù)(51.21±8.47%)明顯低于敏感組(55.25±7.10%),且極重度抵抗組(47.27±8.21/%)較輕度(53.31±6.88%)、中度(52.15±10.63%)、重度(52.04±6.69%)組明顯降低,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。5.胰島素抵抗組再發(fā)心絞痛(33.96%)、心力衰竭(23.58%)發(fā)生率均高于敏感組,差異具有統(tǒng)計(jì)學(xué)意義(p0.05),全因死亡(9.43%)、再發(fā)心肌梗死(8.49%)、卒中(8.49%)及支架內(nèi)血栓(4.72%)發(fā)生率雖高于敏感組,但無統(tǒng)計(jì)學(xué)差異(p0.05)。6.急性心�；颊甙l(fā)生MACCE事件的危險(xiǎn)因素為HOMA-IR、LVEF。所建立的回歸方程為Y(MACCE)=3.013+0.039×HOMA-IR-0.100×LVEF。7.應(yīng)用ROC曲線評(píng)價(jià)HOMA-IR指數(shù)對(duì)急性心�；颊進(jìn)ACCE事件的早期預(yù)測(cè)價(jià)值,所得AUC為0.611,95%可信區(qū)間(confidence interval,CI)為0.531~0.691(P0.01)。結(jié)論:1.胰島素抵抗患者高血壓、糖尿病患病率明顯增加,表明胰島素抵抗與高血壓、糖尿病具有相關(guān)性。2.胰島素抵抗患者體質(zhì)指數(shù)、血脂、空腹血糖、空腹胰島素及炎癥反應(yīng)水平明顯升高,提示胰島素抵抗與肥胖、高脂血癥、炎癥反應(yīng)相關(guān)。3.胰島素抵抗患者冠脈病變嚴(yán)重,冠脈病變范圍廣泛,且冠脈病變類型以彌漫性小病變?yōu)橹鳌?.HOMA-IR、LVEF是急性心�；颊進(jìn)ACCE事件發(fā)生的獨(dú)立危險(xiǎn)因素,胰島素抵抗對(duì)心�；颊哳A(yù)后產(chǎn)生不良影響。5.胰島素抵抗對(duì)急性心�；颊進(jìn)ACCE事件具有一定的預(yù)測(cè)價(jià)值。
[Abstract]:Objective: To investigate the clinical distribution of insulin resistance in patients with acute myocardial infarction receiving direct percutaneous coronary intervention, and to understand the relationship between insulin resistance and coronary artery disease in patients with acute myocardial infarction. The correlation between insulin resistance and the prognosis of patients with myocardial infarction in hospital and in patients with myocardial infarction was investigated through the follow-up of the incidence of MACCE events within 1 years. 202 patients with acute myocardial infarction receiving direct percutaneous coronary intervention in Tianjin Taida International Cardiovascular Disease Hospital from year to year to the year were selected as the subjects of acute myocardial infarction. The insulin resistance was evaluated by the homeostasis model insulin resistance index (Homeostasis model assessment of insulin resistance HOMA-IR). IRI=[empty fasting blood glucose (mmol/L) * empty stomach insulin (U/L)] 22.5, defined as insulin resistance with IRI > 2.69, and IRI2.69 as insulin sensitive. According to the insulin resistance index, the subjects were divided into insulin resistance group and sensitive group, and the patients were divided into four groups of light, medium, heavy and extremely severe with four quantiles. All patients were recorded. Sex, age, weight, height, history of hypertension, diabetes, smoking history, and detection of triglyceride TG, total cholesterol (total cholesterol TC), low density lipoprotein (low-density lipoprotein LDL), high density lipoprotein (high density lipoprotein HDL), and hypersensitive reactive protein. S-CRP), homocysteine (homocysteinemia HCY), fasting blood glucose (fasting plasma glucose FPG), fasting insulin (Fasting serum insulin FINS), creatinine (creatinite), uric acid level. Change range, stent length and diameter to deduce the type of coronary lesion, analyze the correlation between insulin resistance and the factors of coronary lesions above. Record the internal diameter of left ventricle (left ventricle LV) and left ventricular ejection fraction (left ventricle ejection fraction LVEF) in patients with acute myocardial infarction (left ventricle ejection fraction LVEF) and evaluate cardiac function. Follow up intervention therapy for patients with myocardial infarction The incidence of MACCE (all deaths, re infarction, myocardial infarction, hospitalized heart failure, angina, stroke, stent thrombosis) within 1 years after the operation was used to evaluate the predictive value of insulin resistance on MACCE events. Results: insulin resistance, male, age, age, age, age, age, age, age, age, age, age, age, age, age, and age of 35-83 years, mean (61 + 12). In the insulin resistance subgroup, there were 26 cases of mild resistance, 16 males, 35-80 years old, average age (63 + 10), 27 cases of moderate resistance, age, average age, age, age, age, age, extreme resistance, age, age, age 43-82, average (63 + 7) years old.2. insulin resistance group. Rate (66.98%), the prevalence of diabetes (33.02%), BMI (25.37 + 2.44/kg/m2), TG (2.31 + 3.42/mmol/L), CR (75.87 + 23.53/umol/L), CRP (23.33 + 31.00/mg/L), FPG (8.70 + 3.55/mmol/L), FINS (17.37 + 11.89/U/L) significantly higher than those of the sensitive patients. 2.01/kg/m2), CRP (36.62 + 41.88/mg/L) was mild, moderate group was significantly higher, TG (4.11 + 6.33/mmol/L), FPG (11.20 + 5.25/mmol/L), FINS (31.17 + 16.36/U/L) was lighter, and severe resistance group was also significantly higher, the difference was statistically significant (P0.05). Age, sex, smoking in insulin resistance group and insulin resistance group. History, TC, LDL, HDL, HCY, UC levels were not statistically significant (P0.05) SYNTAX integral of.3. insulin resistance group (19 + 8.65), the length of the stent was (36.18 + 19.62/mm), the proportion of multibranch lesions (75.47%) was significantly higher than that of the sensitive group, and the diameter of the stent was significantly lower than that of the sensitive group (3.45 + 2.29/mm), and the difference was statistically significant (P0.05) was in the extreme. Severe resistance group (23.56 + 8.27) was mild (16.48 + 8.23), moderate (17.15 + 7.42), severe (18.89 + 9.24), and significant difference (P0.05). In the analysis of insulin resistance subgroup, the length of the stent, diameter, the number of coronary lesions and the left ventricular ejection fraction in the.4. insulin resistance group were not statistically significant (51. (P0.05) (51.). 21 + 8.47%) was significantly lower than that of the sensitive group (55.25 + 7.10%), and the extreme severe resistance group (47.27 + 8.21/%) was mild (53.31 + 6.88%), moderate (52.15 + 10.63%), and severe (52.04 + 6.69%) group significantly decreased, the difference was statistically significant (P0.05).5. insulin resistance group, recurrent angina (33.96%), heart failure (23.58%) incidence was higher than the sensitive group, the difference Statistically significant (P0.05), total death (9.43%), recurrent myocardial infarction (8.49%), stroke (8.49%) and stent thrombosis (4.72%) were higher than those in the sensitive group, but there was no statistically significant difference (P0.05) the risk factor of MACCE in.6. acute myocardial infarction patients was HOMA-IR, and the regression equation established by LVEF. was Y (MACCE) =3.013+0.039 x HOMA-IR-0.10. 0 x LVEF.7. used the ROC curve to evaluate the early predictive value of HOMA-IR index to the MACCE event in patients with acute myocardial infarction. The results showed that AUC was 0.611,95% confidence interval (confidence interval, CI) was 0.531~0.691 (P0.01). Conclusion: 1. insulin resistance patients with hypertension, the prevalence of diabetes is significantly increased, indicating that insulin resistance and hypertension, diabetes have The level of body mass index, blood lipid, fasting blood glucose, fasting insulin and inflammatory response in patients with.2. insulin resistance increased significantly, suggesting that insulin resistance is related to obesity, hyperlipidemia, and inflammatory response in patients with.3. insulin resistance, the coronary lesions are serious, the coronary lesion range is wide, and the type of coronary lesion is mainly diffuse small lesions.4.HOM A-IR and LVEF are independent risk factors for the occurrence of MACCE events in patients with acute myocardial infarction. Insulin resistance has a bad effect on the prognosis of patients with myocardial infarction..5. insulin resistance is of certain predictive value for the MACCE event in patients with acute myocardial infarction.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R542.22
本文編號(hào)：2121462
[Abstract]:Objective: To investigate the clinical distribution of insulin resistance in patients with acute myocardial infarction receiving direct percutaneous coronary intervention, and to understand the relationship between insulin resistance and coronary artery disease in patients with acute myocardial infarction. The correlation between insulin resistance and the prognosis of patients with myocardial infarction in hospital and in patients with myocardial infarction was investigated through the follow-up of the incidence of MACCE events within 1 years. 202 patients with acute myocardial infarction receiving direct percutaneous coronary intervention in Tianjin Taida International Cardiovascular Disease Hospital from year to year to the year were selected as the subjects of acute myocardial infarction. The insulin resistance was evaluated by the homeostasis model insulin resistance index (Homeostasis model assessment of insulin resistance HOMA-IR). IRI=[empty fasting blood glucose (mmol/L) * empty stomach insulin (U/L)] 22.5, defined as insulin resistance with IRI > 2.69, and IRI2.69 as insulin sensitive. According to the insulin resistance index, the subjects were divided into insulin resistance group and sensitive group, and the patients were divided into four groups of light, medium, heavy and extremely severe with four quantiles. All patients were recorded. Sex, age, weight, height, history of hypertension, diabetes, smoking history, and detection of triglyceride TG, total cholesterol (total cholesterol TC), low density lipoprotein (low-density lipoprotein LDL), high density lipoprotein (high density lipoprotein HDL), and hypersensitive reactive protein. S-CRP), homocysteine (homocysteinemia HCY), fasting blood glucose (fasting plasma glucose FPG), fasting insulin (Fasting serum insulin FINS), creatinine (creatinite), uric acid level. Change range, stent length and diameter to deduce the type of coronary lesion, analyze the correlation between insulin resistance and the factors of coronary lesions above. Record the internal diameter of left ventricle (left ventricle LV) and left ventricular ejection fraction (left ventricle ejection fraction LVEF) in patients with acute myocardial infarction (left ventricle ejection fraction LVEF) and evaluate cardiac function. Follow up intervention therapy for patients with myocardial infarction The incidence of MACCE (all deaths, re infarction, myocardial infarction, hospitalized heart failure, angina, stroke, stent thrombosis) within 1 years after the operation was used to evaluate the predictive value of insulin resistance on MACCE events. Results: insulin resistance, male, age, age, age, age, age, age, age, age, age, age, age, age, age, and age of 35-83 years, mean (61 + 12). In the insulin resistance subgroup, there were 26 cases of mild resistance, 16 males, 35-80 years old, average age (63 + 10), 27 cases of moderate resistance, age, average age, age, age, age, age, extreme resistance, age, age, age 43-82, average (63 + 7) years old.2. insulin resistance group. Rate (66.98%), the prevalence of diabetes (33.02%), BMI (25.37 + 2.44/kg/m2), TG (2.31 + 3.42/mmol/L), CR (75.87 + 23.53/umol/L), CRP (23.33 + 31.00/mg/L), FPG (8.70 + 3.55/mmol/L), FINS (17.37 + 11.89/U/L) significantly higher than those of the sensitive patients. 2.01/kg/m2), CRP (36.62 + 41.88/mg/L) was mild, moderate group was significantly higher, TG (4.11 + 6.33/mmol/L), FPG (11.20 + 5.25/mmol/L), FINS (31.17 + 16.36/U/L) was lighter, and severe resistance group was also significantly higher, the difference was statistically significant (P0.05). Age, sex, smoking in insulin resistance group and insulin resistance group. History, TC, LDL, HDL, HCY, UC levels were not statistically significant (P0.05) SYNTAX integral of.3. insulin resistance group (19 + 8.65), the length of the stent was (36.18 + 19.62/mm), the proportion of multibranch lesions (75.47%) was significantly higher than that of the sensitive group, and the diameter of the stent was significantly lower than that of the sensitive group (3.45 + 2.29/mm), and the difference was statistically significant (P0.05) was in the extreme. Severe resistance group (23.56 + 8.27) was mild (16.48 + 8.23), moderate (17.15 + 7.42), severe (18.89 + 9.24), and significant difference (P0.05). In the analysis of insulin resistance subgroup, the length of the stent, diameter, the number of coronary lesions and the left ventricular ejection fraction in the.4. insulin resistance group were not statistically significant (51. (P0.05) (51.). 21 + 8.47%) was significantly lower than that of the sensitive group (55.25 + 7.10%), and the extreme severe resistance group (47.27 + 8.21/%) was mild (53.31 + 6.88%), moderate (52.15 + 10.63%), and severe (52.04 + 6.69%) group significantly decreased, the difference was statistically significant (P0.05).5. insulin resistance group, recurrent angina (33.96%), heart failure (23.58%) incidence was higher than the sensitive group, the difference Statistically significant (P0.05), total death (9.43%), recurrent myocardial infarction (8.49%), stroke (8.49%) and stent thrombosis (4.72%) were higher than those in the sensitive group, but there was no statistically significant difference (P0.05) the risk factor of MACCE in.6. acute myocardial infarction patients was HOMA-IR, and the regression equation established by LVEF. was Y (MACCE) =3.013+0.039 x HOMA-IR-0.10. 0 x LVEF.7. used the ROC curve to evaluate the early predictive value of HOMA-IR index to the MACCE event in patients with acute myocardial infarction. The results showed that AUC was 0.611,95% confidence interval (confidence interval, CI) was 0.531~0.691 (P0.01). Conclusion: 1. insulin resistance patients with hypertension, the prevalence of diabetes is significantly increased, indicating that insulin resistance and hypertension, diabetes have The level of body mass index, blood lipid, fasting blood glucose, fasting insulin and inflammatory response in patients with.2. insulin resistance increased significantly, suggesting that insulin resistance is related to obesity, hyperlipidemia, and inflammatory response in patients with.3. insulin resistance, the coronary lesions are serious, the coronary lesion range is wide, and the type of coronary lesion is mainly diffuse small lesions.4.HOM A-IR and LVEF are independent risk factors for the occurrence of MACCE events in patients with acute myocardial infarction. Insulin resistance has a bad effect on the prognosis of patients with myocardial infarction..5. insulin resistance is of certain predictive value for the MACCE event in patients with acute myocardial infarction.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R542.22
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