摘要
目的:探讨胰岛素抵抗对急性心肌梗死患者经皮冠状动脉介入治疗(PCI)术后血浆内皮素,血管性血友病因子、血小板膜糖蛋白Ⅱb/Ⅲa受体水平及心肌组织灌注的影响。方法:根据稳态模式评估法的胰岛素指数(HOMA-IR)将128例急性心肌梗死患者分为两组,HOMA-IR≥5为胰岛素抵抗组72例,HOMA-IR<5为非胰岛素抵抗组56例。所有入选病例均于发病后24h内行PCI,并于术中行心肌灌注分级评价心肌微循环灌注情况,分别于PCI术前、术后即刻、30min、4h、12h、24h、48h、72h、7d取外周静脉血,编码血浆标本,在-80℃条件下保存,分批检测血浆内皮素、血管性血友病因子及血小板膜糖蛋白Ⅱb/Ⅲa受体。并连续观察PCI术前、后血浆内皮素、血管性血友病因子、血小板膜糖蛋白Ⅱb/Ⅲa受体变化。结果:两组患者血浆血管性血友病因子水平、血小板膜糖蛋白Ⅱb/Ⅲa受体水平、内皮素水平变化:胰岛素抵抗组各时间点较非胰岛素抵抗组均明显升高,差异均有统计学意义(P均<0.05)。心肌梗死溶栓治疗临床试验(TIMI)3级的比率变化:128例患者均行PCI治疗开通梗死相关动脉,依据TIMI分级标准,造影显示术后两组患者TIMI3级的比率差异无统计学意义(P>0.05)。TIMI心肌灌注分级(TMPG)分析显示:非胰岛素抵抗组56例患者中有53例(94.6%)心肌组织灌注良好,可达TMPG2～3级,胰岛素抵抗组72例患者中有53例(73.6%)心肌组织灌注良好,可达TMPG2～3级,两组比较差异有统计学意义(P<0.05)。结论:胰岛素抵抗会影响急性心肌梗死患者PCI术后血管内皮功能、凝血功能及心肌组织灌注。
Objective： To investigate the effect of insulin resistance （IR） on plasma concentrations of endothelium （ET）, Von willebrand factor （vWF） , GP Ⅱ b/Ⅲa receptor （ CD41 ） and myocardial perfusion in patients with acute myocardial infarction （ AMI ） be- fore and after percutaneous coronary intervention（PCI）. Methods：A total of 128 AMI patients underwent PCI were divided into two groups： insulin resistance group, HOMA-IR 〉 5, n = 72 （IR group）, and non-insulin resistance group, HOMA-IR 〈 5, n = 56 （non-IR group）. All patients were diagnosed with emergency coronary angiography. After PCI, we examined the plasma concentrations of ET, vWF and GP Ⅱ b/Ⅲ a receptor （ CD41 ） ; we also estimated the myocardial peffusion according to myocardial blush grade （MBG）. Peripheral plasma samples of EF, vWF and GP Ⅱ b/Ⅲ a receptor（ CD41 ） were taken immediately before PCI ; immediately after PCI and 30 rain ,4 h, 12 h ,24 h, 48 h ,72 h and 7 days after PCI respectively. Coded blood samples were stored at - 80℃ and analyzed in both groups. The changes of EF, vWF and GP Ⅱ bⅢ a receptor（ CD41 ）were compared before and after PCI. Results： The plasma concentrations of ET, vWF and CD41 were significantly higher in IR group than non-IR group （P 〈 0. 05 ）. Myocardial perfusion was better in non-IR group than in IR group after PCI. Conculation ： Higher plasma concentrations of ET, vWF and CD41 after PCI in patients with acute AMI was related to insulin resistance
出处
《中国循环杂志》
CSCD
北大核心
2008年第5期336-339,共4页
Chinese Circulation Journal
基金
河北省科技厅计划内课题(05276141)
关键词
心肌梗死
血管成形术
胰岛素抵抗
Myocardial infarction
Percutaneous coronary intervention
Insulin resistance
