【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。更多还原

【Abstract】 Objective:To investigate the effect of insulin resistance (IR) on plasma concentrations of endothelium (ET),Von willebrand factor (vWF),GPⅡb/Ⅲa receptor(CD41)and myocardial perfusion in patients with acute myocardial infarction(AMI) before 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 GPⅡb/Ⅲa receptor(CD41); we also estimated the myocardial perfusion according to myocardial blush grade (MBG). Peripheral plasma samples of EF,vWF and GPⅡb/Ⅲa receptor(CD41)were taken immediately before PCI; immediately after PCI and 30 min,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 GPⅡb/Ⅲa 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.更多还原