冠心病合并2型糖尿病患者冠状动脉病变与胰岛素抵抗的相关性分析

doi:10.3969/j.issn.1004-583X.2023.01.005

摘要/Abstract

摘要：

目的探讨冠心病合并2型糖尿病患者冠状动脉缺血及钙化程度与胰岛素抵抗的相关性。方法选择2020年1月1日至2022年1月1日在上饶市人民医院明确诊断为冠心病且伴有2型糖尿病的患者80例。根据稳态模型的胰岛素抵抗指数(insulin resistance index in a homeostasis model,HOMA-IR)将患者分为两组:HOMA-IR>2.69为A组( $n$ =42)、HOMA-IR≤2.69为B组( $n$ =38),并比较两组靶血管钙化长度、靶血管钙化弧度、冠状动脉病变支数、支架覆盖病变长度及Gensini积分的差异性,以及HOMA-IR与上述各项指标的相关性。结果与B组比较,A组靶血管钙化长度较长、靶血管钙化弧度较大、冠状动脉病变数目较多、支架覆盖病变长度较长、Gensini积分较高,差异均有统计学意义( $P$ <0.05)。Pearson相关分析显示,靶血管钙化长度、靶血管钙化弧度、冠状动脉病变数目、支架覆盖病变长度、Gensini积分与HOMA-IR呈正相关( $r$ 分别为0.75、0.51、0.43、0.38、0.59,均 $P$ <0.05)。结论冠心病合并2型糖尿病的患者胰岛素抵抗与冠状动脉缺血及钙化程度呈正相关。

关键词: 冠心病, 糖尿病, 2型, 冠状动脉钙化, 胰岛素抵抗

Abstract:

Objective To investigate the correlation between the ischemic degree of coronary artery and calcification and insulin resistance in patients with coronary heart disease combined with type 2 diabetes mellitus (T2DM). Methods From January 1, 2020 to January 1, 2022, 80 patients with coronary heart disease combined with T2DM treated in the Shangrao People’s Hospital were recruited. According to the insulin resistance index in a homeostasis model (HOMA-IR), patients were divided into group A (HOMA-IR>2.69, $n$ =42), and group B (HOMA-IR≤2.69, $n$ =38).The length and arc of calcified vessels, number of coronary artery lesions, length of stent covering coronary arterylesions and Gensini score between the two groups were compared. The correlation between HOMA-IR and the above indicators was identified. Results Compared with those of group B, significantly longer length of calcified vessels and stent covering coronary artery lesions, larger arc of calcified vessels and number of coronary artery lesions, and higher Gensini scores were detected in group A (all $P$ <0.05).Pearson correlation analysis showed that the length and arc of calcified vessels, number of coronary artery lesions, length of stent covering coronary arterylesions and Gensini scorewere positively correlated with HOMA-IR ( $r$ =0.75, 0.51, 0.43, 0.38, and 0.59, respectively, all $P$ <0.05). Conclusion There is a positive correlation between insulin resistance and coronary artery ischemia and calcification in patients with coronary heart disease combined with T2DM.

Key words: coronary disease, diabetes mellitus, type 2, coronary artery calcification, insulin resistance

中图分类号:

R541.4

张上仕, 朱红艳, 李楠, 陈鹰熙. 冠心病合并2型糖尿病患者冠状动脉病变与胰岛素抵抗的相关性分析[J]. 临床荟萃, 2023, 38(1): 46-49.

Zhang Shangshi, Zhu Hongyan, Li Nan, Chen Yingxi. Correlation between coronary artery lesion and insulin resistance in patients with coronary heart disease combined with type 2 diabetes mellitus[J]. Clinical Focus, 2023, 38(1): 46-49.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.01.005

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I1/46

图/表 4

表1 两组一般资料比较

Tab.1 Comparison of general data between groups

组别	例数	男性 [例(%)]	年龄 (岁)	吸烟史 (年)	饮酒史 (年)	糖尿病病程 (年)	BMI (kg/m²)	高血压 [例(%)]	抗血小板 [例(%)]	他汀类 [例(%)]
A组	42	30(71.4)	71.1±0.9	24.1±1.3	30.3±0.8	10.6±0.5	26.2±0.3	37(88.1)	29(69.0)	39(92.9)
B组	38	27(71.1)	69.6±0.7	23.6±1.1	32±1.4	9.8±0.4	25.6±0.1	33(86.8)	28(73.7)	35(92.1)
$t$ /χ²值		2.80	0.00	0.04	0.06	1.30	0.43	0.12	1.15	2.47
$P$ 值		0.18	1.26	0.35	2.16	0.34	0.06	0.09	6.23	3.91

表1 两组一般资料比较

Tab.1 Comparison of general data between groups

组别	例数	男性 [例(%)]	年龄 (岁)	吸烟史 (年)	饮酒史 (年)	糖尿病病程 (年)	BMI (kg/m²)	高血压 [例(%)]	抗血小板 [例(%)]	他汀类 [例(%)]
A组	42	30(71.4)	71.1±0.9	24.1±1.3	30.3±0.8	10.6±0.5	26.2±0.3	37(88.1)	29(69.0)	39(92.9)
B组	38	27(71.1)	69.6±0.7	23.6±1.1	32±1.4	9.8±0.4	25.6±0.1	33(86.8)	28(73.7)	35(92.1)
$t$ /χ²值		2.80	0.00	0.04	0.06	1.30	0.43	0.12	1.15	2.47
$P$ 值		0.18	1.26	0.35	2.16	0.34	0.06	0.09	6.23	3.91

表2 两组实验室资料比较

Tab. 2 Comparison of laboratory data between groups

组别	例数	FINS (mU/L)	FBG (mmol/L)	2 hPBG (mmol/L)	HbA₁c (mmol/L)	LDL-C (mmol/L)	HDL-C (mmol/L)	TG (mmol/L)	TC (mmol/L)	尿酸 (mmol/L)	eGFR[ml/ (min·1.73 m²)]
A组	42	5.6±0.2	7.8±0.3	12.2±0.4	7.8±0.2	2.4±0.04	1.3±0.01	3.1±0.03	4.3±0.06	392.5±3.1	61.4±1.4
B组	38	4.5±0.1	7.3±0.2	12.1±0.1	7.5±0.1	2.3±0.03	1.3±0.02	3.2±0.04	4.1±0.05	387±2.8	63.5±1.7
$t$ /χ²值		1.31	0.52	0.34	2.29	0.02	1.46	0.07	0.18	1.13	2.17
$P$ 值		0.00	0.00	2.17	1.24	2.24	4.31	0.78	0.19	3.61	0.83

表2 两组实验室资料比较

Tab. 2 Comparison of laboratory data between groups

组别	例数	FINS (mU/L)	FBG (mmol/L)	2 hPBG (mmol/L)	HbA₁c (mmol/L)	LDL-C (mmol/L)	HDL-C (mmol/L)	TG (mmol/L)	TC (mmol/L)	尿酸 (mmol/L)	eGFR[ml/ (min·1.73 m²)]
A组	42	5.6±0.2	7.8±0.3	12.2±0.4	7.8±0.2	2.4±0.04	1.3±0.01	3.1±0.03	4.3±0.06	392.5±3.1	61.4±1.4
B组	38	4.5±0.1	7.3±0.2	12.1±0.1	7.5±0.1	2.3±0.03	1.3±0.02	3.2±0.04	4.1±0.05	387±2.8	63.5±1.7
$t$ /χ²值		1.31	0.52	0.34	2.29	0.02	1.46	0.07	0.18	1.13	2.17
$P$ 值		0.00	0.00	2.17	1.24	2.24	4.31	0.78	0.19	3.61	0.83

表3 两组冠脉缺血及钙化程度比较

Tab. 3 Comparison of coronary artery ischemia and calcification between groups

组别	例数	植入支架患者 [例(%)]	靶血管钙化长度 (mm)	靶血管钙化弧度 (°)	冠脉病变数目 (支)	支架覆盖病变长度(mm)	Gensini积分 (分)
A组	42	22(52.4)	21±1.3	226±23.5	2.1±0.5	47±2.1	32±5.6
B组	38	16(42.1)	17±0.8	153±17.4	1.6±0.5	31±1.6	27.2±4.9
$t$ /χ²值		0.74	0.58	6.23	2.61	0.32	3.42
$P$ 值		0.01	0.01	0.00	0.00	0.02	0.00

表3 两组冠脉缺血及钙化程度比较

Tab. 3 Comparison of coronary artery ischemia and calcification between groups

组别	例数	植入支架患者 [例(%)]	靶血管钙化长度 (mm)	靶血管钙化弧度 (°)	冠脉病变数目 (支)	支架覆盖病变长度(mm)	Gensini积分 (分)
A组	42	22(52.4)	21±1.3	226±23.5	2.1±0.5	47±2.1	32±5.6
B组	38	16(42.1)	17±0.8	153±17.4	1.6±0.5	31±1.6	27.2±4.9
$t$ /χ²值		0.74	0.58	6.23	2.61	0.32	3.42
$P$ 值		0.01	0.01	0.00	0.00	0.02	0.00

表4 冠脉病变与HOMA-IR水平的相关性

Tab. 4 Correlation between coronary artery disease and HOMA-IR level

项目	$r$ 值	$P$ 值
靶血管钙化长度	0.75	0.00
靶血管钙化弧度	0.51	0.00
冠脉病变数目	0.43	0.01
支架覆盖病变长度	0.38	0.01
Gensini积分	0.59	0.00

表4 冠脉病变与HOMA-IR水平的相关性

Tab. 4 Correlation between coronary artery disease and HOMA-IR level

项目	$r$ 值	$P$ 值
靶血管钙化长度	0.75	0.00
靶血管钙化弧度	0.51	0.00
冠脉病变数目	0.43	0.01
支架覆盖病变长度	0.38	0.01
Gensini积分	0.59	0.00

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