【摘要】 目的探讨无糖尿病的不稳定心绞痛患者血浆游离脂肪酸(freefattyacids,FFA)与胰岛素抵抗(insulinresistance,IR)的关系。方法不稳定心绞痛组为经冠状动脉造影确诊不稳定型心绞痛的无糖尿病患者42例,对照组为经冠状动脉造影排除了冠心病患者30例,行75g葡萄糖口服耐量试验,分别测定空腹、餐后30min、120min血糖、胰岛素及FFA水平。结果伴IR患者在不稳定心绞痛组26例(26/42),对照组为12例(12/30),(P=0.066);在不稳定心绞痛组,伴IR患者空腹和餐后120min,FFA分别为(0.63±0.16)mmol/L和(0.16±0.07)mmol/L;高于无IR患者,空腹和餐后120min值为(0.48±0.21)mmol/L和(0.07±0.06)mmol/L(P<0.05);稳态模型评估胰岛素抵抗(homeostasismodelassay-insulinresistanceindex,HOMA-IR)增高(0.50±0.20与0.36±0.22,P<0.05),胰岛素敏感指数(insulinsensitivityindex,HOMA-ISI)降低(-1.96±0.20与-1.71±0.22,P<0.05);不稳定心绞痛组和对照组伴IR患者比较,FFA明显高于对照组,分别为[(0.63±0.16)mmol/L与(0.48±0.22)mmol/L,P<0.05,(0.16±0.07)mmol/L与(0.08±0.03)mmol/L,P<0.01]。相关分析显示HOMA-IR与体重指数呈正相关(r=0.51,P<0.01);餐后30minFFA与HOMA-IR呈正相关(r=0.44,P<0.05);餐后120minFFA分别与空腹胰岛素(r=0.55,P<0.05)、餐后120min血糖呈正相关(r=0.432,P<0.05);游离脂肪酸曲线下面积(FFAAUC)与HOMA-IR(r=0.492,P<0.05)、体重指数(r=0.94,P<0.0001)、腰围(r=0.41,P<0.05)、臀围(r=0.40,P<0.05)和餐后120min胰岛素(r=0.90,P<0.0001)呈正相关。多重逐步回归分析显示,HOMA-IR与体重指数、餐后120minFFA呈正相关。结论FFA与无糖尿病的不稳定心绞痛患者胰岛素抵抗存在密切关系,餐后120minFFA有可能作为评价这类患者胰岛素抵抗的间接辅助诊断指标。更多还原

【Abstract】 Objectives To find the relationship between free fatty acids(FFA) and insulin resistance (IR) in patients with unstable angina(UA) and no diabetes mellitus. Methods 42 patients with UA, hospitalized between June 2003 and January 2004 were enrolled in the study. Another 30 patients who claimed of chest pain but were found without coronary heart disease conformed by coronary angiography, were selected as the control. An oral glucose tolerance test was given with 75 g glucose, and blood samples were taken at 0 min, 30 min and 120 min later to be tested in glucose, insulin, C-peptide and FFA plasma levels. Results Cases of 26(61.9%) and 12(40%) IR existed in the UA group and the control group. 0 min FFA, 120 min FFA were significantly different between the IR and the non-IR patients in the UA group (0.63±0.16 vs 0.48±0.21 mmol/L,P<0.05, 0.16±0.07 vs 0.07±0.06 mmol/L,P<0.001); HOMA-IR was significantly increased and HOMA-ISI was decreased (0.5±0.20 vs 0.36±0.22, P<0.05,-1.96±0.198 vs-1.71±0.22,P<0.05).With the IR in the UA group,30 min FFA was positively correlated with HOMA-IR(r=0.44 P<0.005), and it was negatively with HOMA-ISI(r=-0.414,P<0.05). 120 min FFA was positively correlated with FINS(r=0.55,P<0.05). FFAAUC was positively correlated with HOMA-IR, BMI, Waist, hip and 120 min INS(r=0.47,P<0.05,r=0.94, P<0.0001, r=0.41,P<0.05,r=0.40,P<0.05 and r=0.90,P<0.0001). It was negatively correlated with 30 min PG(r=0.489, P<0.05). Multiple regression analysis of HOMA-IR that showed it was positively correlated with BMI and negatively with 120 min FFA. Conclusions The high FFA level promotes IR while HOMA-IR and INS are significant increased in the UA patients without diabetes mellitus. Multiple regression analysis shows that HOMA-IR is more closely correlated with BMI and FFA. Together with them,120 min FFA is an assistance judgement index of IR among UA patients without diabetes mellius.更多还原