冠心病患者血清真胰岛素、胰岛素原水平变化及其及血脂关系.docVIP

冠心病患者血清真胰岛素、胰岛素原水平变化及其及血脂关系 　 作者：金艳,杨承健,徐欣,曹佳宁,叶新和,张月军 【关键词】 冠心病;胰岛素抗药性(胰岛素抵抗）;真胰岛素;胰岛素原;血脂异常 　　[摘要]目的 探讨冠心病(CHD）患者血清真胰岛素（TI）、胰岛素原（PI）水平,并分析其与CHD危险因子的关系。方法 对40例确诊CHD患者和40例正常人采用高度特异性的ELISA法分别检测空腹血清TI、PI水平；以RIA法检测空腹血清免疫活性胰岛素（IRI）水平;同时检测这两组对象的空腹和餐后2h血糖、血脂以及血压。结果 CHD组IRI、TI、PI水平均高于对照组（Plt;0.05）,而胰岛素敏感指数（ISI）则低于对照组（Plt;0.05）；CHD组中TI、PI与年龄、体重指数（BMI）、血糖和血脂均有独立的相关关系。结论 CHD患者有高胰岛素血症和胰岛素抵抗状态,TI、PI分别与血糖、血脂等CHD危险因子呈群聚关系。 　　[关键词]冠心病;胰岛素抗药性(胰岛素抵抗）;真胰岛素;胰岛素原;血脂异常 　　Change of concentrations of true insulin，proinsulin in patients with coronary heart disease,and the probable relationship to serum lipid 　　Abstract：Objective To explore the relation between the levels of serum true insulin （TI）,proinsulin （PI）levels in patients with coronary heart disease (CHD）and other cardiovascular risk factors.Methods TI and PI were determined by highly specific ELISA assays and immunoreactive insulin （IRI）was measured by RIA.The fasting serum IRI,TI,PI levels in 40 nondiabetic patients with CHD and 40 healthy,same aged control subject were investigated.And the fasting and 2h postprandial plasma glucose,serum lipids and blood pressure were also determined in each individual.Results The levels of serum IRI,TI and PI in patients with CHD were significantly higher than those in controls （Plt;0.05）,while the value of insulin sensitivity index （ISI）in patients with CHD was lower than that in controls （Plt;0.05）.There were significant independent correlations between TI and the factors of age,BMI,plasma glucose,serum lipids and PI also relates with the above factors.Conclusion Nondiabetic patients with CHD have hyperinsulinemia and insulin resistance and there is an independent association between proinsulin and dyslipidemia. 　　Key words: coronary heart disease; insulin resistance; true insulin; proinsulin; dyslipidemia　(Modern Medical Journal,2007,35:1416) 　　近20年来国内外许多研究表明,胰岛素抵抗（IR）和高胰岛素血症在冠心病(CHD）的发生中起着重要的作用[1]。近年来胰岛素的前体物质胰岛素原(PI）在CHD中的作用渐受重视[2]。研究表明，2型糖尿病患者普遍存在高PI血症，PI在这类患者中与诸多CHD危险因子密切相关，且这种相关性强于胰岛素[3