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目的:探讨冠心病患者胰岛素抵抗与高敏C反应蛋白(hs-CRP)及冠状动脉严重程度间的关系。方法:连续收集冠状动脉造影证实至少有1支血管狭窄≥50%的92例患者作为研究对象,按临床表现分为稳定型心绞痛(SA)41例和急性冠状动脉综合征(ACS)51例,按冠状动脉病变程度分为单支病变组35例、双支病变组28例及3支以上病变组29例。分别测定其空腹血糖、血浆胰岛素、hs-CRP、冠状动脉Genisini评分,用自我平衡模式分析法(HOMA-IRI)作为评价胰岛素抵抗程度的指标。分析胰岛素抵抗、hs-CRP、冠状动脉病变3者间的关系。结果:①SA组与ACS组:hs-CRP(3.34±3.91∶18.39±15.93)、胰岛素抵抗指数(IRI)(1.57±0.96∶3.09±1.64)、Genisini评分(35.31±28.32∶64.74±32.83)差异均有统计学意义(均P<0.01)。②单支病变组与双支、≥3支病变组比较:hs-CRP差异无统计学意义,P>0.05;IRI(2.04±1.17∶2.28±1.64∶3.61±1.53)差异有统计学意义,P<0.05;进一步两两比较后,单支病变组与≥3支病变组的hs-CRP(8.68±11.08∶18.24±18.30)差异有统计学意义,P<0.05。③Gensini评分与IRI、hs-CRP呈正相关(r=0.508,P<0.01;r=0.489,P<0.01),hs-CRP与IRI亦呈正相关(r=0.536,P<0.01)。结论:胰岛素抵抗、hs-CRP与冠状动脉病变程度呈正相关。
Objective: To investigate the relationship between insulin resistance and high-sensitivity C-reactive protein (hs-CRP) and the severity of coronary artery in patients with coronary heart disease. Methods: A total of 92 patients with coronary artery angiography confirmed at least 1 vessel stenosis ≥50% were divided into 41 cases of stable angina pectoris (SA) and 51 cases of acute coronary syndrome (ACS) according to the clinical manifestations. According to the extent of coronary artery lesions were divided into single-vessel disease group 35 cases, double-vessel disease group 28 cases and more than 3 lesions in 29 cases. The fasting blood glucose, plasma insulin, hs-CRP and coronary artery Genisini score were measured respectively. HOMA-IRI was used as an index to evaluate the degree of insulin resistance. Analysis of insulin resistance, hs-CRP, coronary artery disease between the three. Results: ①The difference of hs-CRP (3.34 ± 3.91:18.39 ± 15.93), IRI (1.57 ± 0.96: 3.09 ± 1.64) and Genisini score (35.31 ± 28.32:64.74 ± 32.83) in both SA group and ACS group There was statistical significance (all P <0.01). ② There was no significant difference in hs-CRP between single-vessel disease group and double-vessel disease, ≥3 vessel disease group, P> 0.05; IRI was 2.04 ± 1.17:2.28 ± 1.64:3.61 ± 1.53, the difference was statistically significant, P <0.05; After further comparison, the difference of hs-CRP (8.68 ± 11.08:18.24 ± 18.30) between single-vessel disease group and ≥3 vessel disease group was statistically significant (P <0.05). There was a positive correlation between Gensini score and IRI and hs-CRP (r = 0.508, P <0.01; r = 0.489, P <0.01). Conclusion: Insulin resistance, hs-CRP and coronary artery lesions were positively correlated.