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目的 探讨代谢综合征 (MS)及合并冠心病 (CHD)的老年患者空腹血清总同型半胱氨酸 (totalhomocysteine ,tHcy)水平和胰岛素敏感性及与MS其他成分的相互关系。方法 用化学免疫发光法测定单纯MS组 ( 34例 )、MS合并CHD组 ( 30例 )和正常对照组 ( 16例 )空腹血清tHcy水平 ,并收集MS的其他有关数据 :体重指数、空腹血糖、空腹血浆胰岛素、糖化血红蛋白 (HbA1c)和血脂 ,计算胰岛素敏感指数 (ISI)。结果 tHcy在正常对照组 ( 10 .9± 3.8)μmol L,MS组 ( 14 .3± 4 .2 ) μmol L ,MS +CHD组 ( 19.2± 2 .9) μmol L ,3组间差异有显著性意义 ;空腹血清tHcy水平与ISI呈负相关 ( r =- 0 .2 2 1,P<0 .0 5 ) ;与体重指数 ( r =0 .12 5 ,P<0 .0 5 )、空腹血糖 ( r =0 .2 18,P<0 .0 5 )和HbA1c(r=0 .312 ,P <0 .0 5 )呈正相关 ;以空腹血清tHcy水平为应变量的logistic多元逐步回归分析提示 ,ISI(r2 =0 .2 3)、HbA1c( r2 =0 .2 1)和血清甘油三酯水平 ( r2 =0 .15 )与tHcy具有相关性 ( P <0 .0 5 )。结论 MS患者tHcy水平增加 ,合并CHD的MS患者更为明显 ,并与胰岛素敏感性下降相关 ,可能在MS发展为CHD中起一定作用。
Objective To investigate the relationship between fasting serum total homocysteine (tHcy) and insulin sensitivity and other components of MS in elderly patients with metabolic syndrome (MS) and coronary heart disease (CHD). Methods Fasting serum tHcy levels were determined by chemiluminescence immunoassay in MS group (34 cases), MS combined with CHD group (30 cases) and normal control group (16 cases). Other relevant data of MS were collected: body mass index, fasting blood glucose, Fasting plasma insulin, glycosylated hemoglobin (HbA1c), and lipids, and calculate the insulin sensitivity index (ISI). Results The difference of tHcy in the control group (10.9 ± 3.8) μmol L, MS group (14.3 ± 4.2) μmol L, MS + CHD group (19.2 ± 2.9) μmol L, (R = - 0.221, P <0.05), and body weight index (r = 0.125, P <0.05), fasting serum tHcy levels and ISI was negatively correlated There was a positive correlation between blood glucose (r = 0.22, P <0.05) and HbA1c (r = 0.321, P <0.05). The logistic regression analysis based on fasting serum tHcy level , ISI (r2 = 0.23), HbA1c (r2 = 0.21) and serum triglyceride level (r2 = 0.15) were correlated with tHcy (P <0.05). Conclusion The level of tHcy is increased in patients with MS. The MS patients with CHD are more obvious and associated with decreased insulin sensitivity, which may play a role in the development of MS as CHD.