胰岛素抵抗与冠心病关系的病例对照研究

目的　探讨胰岛素抵抗及其他危险因素与冠心病发病的关系 .方法　选择住院确诊的冠心病患者 84例为病例组 ,排除冠心病的住院患者或健康体检者 16 3例为对照组 ,对冠心病常见危险因素进行调查 ,检测空腹血糖、胰岛素水平、血脂、脂蛋白 (a)等相关指标 ,用单因素和多因素分析计算危险因素的优势比 (OR)及 OR 95 %可信限 (95 % CI) ,比较胰岛素水平和胰岛素敏感性等指标 .结果　病例组的空腹胰岛素水平显著高于对照组 ,胰岛素敏感性指数显著低于对照组 (P<0 .0 5 ) ;其他危险因素的单因素分析显示 ,吸烟、高血压病史、高脂饮食习惯、冠心病家族史 ,脂蛋白 (a)水平升高是冠心病的危险因素 ,其 OR分别为 2 .49,2 .5 5 ,3.2 3,2 .5 1和3.76 ,高密度脂蛋白水平是冠心病的保护因素 ,OR值为 0 .2 1;多因素分析结果显示 ,被筛选进入 L ogistic回归方程的变量分别为高密度脂蛋白、脂蛋白 (a)、胆固醇水平和每日吸烟量 .结论　空腹胰岛素水平显著升高和 (或 )胰岛素敏感性降低与冠心病的发病有病因学联系 (P<0 .0 5 ) ,吸烟、高血压病史、高脂饮食习惯、冠心病家族史、脂蛋白 (a)水平升高是冠心病的危险因素 ,高密度脂蛋白水平是冠心病的保护因素 .

Insulin resistance and coronary heart disease

AIM To investigate the relationship between insulin resistance and other risk factors and coronary heart disease (CHD). METHODS Eighty-four CHD inpatients were selected as case group and 163 non-CHD persons from inpatients or healthy population were defined as control group. Major risk factors were investigated and variables such as serum glucose, insulin level, lipids and lipoprotein (a) were checked. Odds ratio (OR) and OR 95% confident interval were measured by uni-variable and multi-variable analysis. Means of insulin level and index of insulin sensitivity were compared between two groups. RESULTS Means of serum insulin level in cases were significantly higher than those of controls, while index of insulin sensitivity was significantly lower than that of control group. Uni-variable analysis indicated that cigarette smoking, hypertension, fat enriched diet, family history of CHD and elevated serum lipoprotein (a) were the risk factors of CHD, with ORs 2.49, 2.55, 3.23, 2.51 and 3.76 respectively. However, high density lipoprotein level was protective factor, with OR 0.21. Multi-variable analysis showed that cigarette smoking, serum levels of HDL-c, Lp(a), total cholesterol and consumption of cigarettes per-day were the variables being selected into logistic equation. CONCLUSION Elevated serum insulin level and decreased index of insulin sensitivity is related to CHD. Cigarette smoking, hypertension, fat enriched diet, family history of CHD and elevated serum lipoprotein (a) are the risk factors of CHD. HDL-c level is a protective factor.