论文标题:冠心病患者血清抵抗素与胰岛素抵抗及冠脉狭窄程度的相关性研究
Study of the Relationship of Serum Resistin Level with Insulin Resistance and the Severity of Coronary Atherosclerosis in the Patients with Coronary Heart Disease
论文作者
论文导师 王旭开,论文学位 硕士,论文专业 内科学
论文单位 第三军医大学,点击次数 122,论文页数 34页File Size1069K
2007-05-01论文网 http://www.lw23.com/lunwen_223636597/
coronary heart disease;;resistin;;insulin ;;insulin resistance
背景与目的 心血管疾病是当前世界上发病率、致死率第一位的疾病,由此越来越受到医学界的关注。作为多病因疾病的冠心病,对其病因的研究近年来成为研究的热点。在病因研究的过程中,大家发现胰岛素抵抗(Insulin resistance,IR)是冠心病发病的一个重要的原因。而抵抗素(resistin,RSTN)的发现为进一步的研究冠心病的致病原因带来了新的思路。 既往的研究表明抵抗素与胰岛素抵抗两者相关性有着相关及不相关的两种截然不同的结果,抵抗素与动脉粥样硬化间的相关性研究也是更多来源于动物实验,并且也存在截然不同的两种结果。 本研究通过测定冠心病患者血清抵抗素水平、胰岛素敏感性指数及冠状动脉狭窄程度,探讨抵抗素与胰岛素抵抗及动脉粥样硬化的关系。 研究方法 1、病例选择选自2005年11月至2006年4月我院住院行冠状动脉造影的患者。其中试验组为经造影检查冠状动脉左主干、左前降支、左回旋支、右冠分支任何一支狭窄≥50%者。对照组为任何一支冠状动脉狭窄程度<50%。病例排除标准:同时合并有肝、肾、胰腺及甲状腺疾病者。 2、一般情况采集:患者的性别、年龄、身高、体重、体重指数的计算。 3、隔夜禁食12小时后采肘静脉血,分别用己糖激酶法测定血浆葡萄糖浓度,放射免疫法检测血清胰岛素浓度,酶联免疫测定法血清测定血清抵抗素浓度。 4、胰岛素敏感性指数( ISI ,即空腹血糖浓度与胰岛素浓度乘积的倒数的自然对数)的计算。 5、冠状动脉造影:诊断标准采用直径法,按冠状动脉粥样硬化程度进行血管狭窄程度记分,采用Gensini冠状动脉狭窄程度评分。 6、将得到结果,应用Spss10.0软件进行数据的处理和统计学分析。 研究结果 1、总共57例患者纳入试验,其中试验组45例(男性32例,女性13例),平均年龄66.5±10.8岁,对照组12例(男性4例、女性8例),平均年龄59.0±11.4岁。 2、血清空腹胰岛素浓度、胰岛素敏感性指数绝对值及血清抵抗素浓度显著大于对照组(P<0.01)。 3、试验组中血清空腹抵抗素浓度与胰岛素浓度呈正相关(r=0.303,P<0.05)。血清空腹抵抗素浓度与胰岛素敏感指数呈负相关(r=-0.296,P<0.05)。血清空腹抵抗素浓度与冠状动脉狭窄程度评分呈显著正相关(r=0.38,P=0.01)。 4、多元逐步回归分析显示,空腹抵抗素浓度是影响胰岛素浓度的独立影响因素(R2=0.120,P<0.05),也是影响冠状动脉狭窄评分的独立因素(R2=0.224,P=0.01)。 研究结论 1、冠心病患者中,血清抵抗素浓度与胰岛素抵抗之间有着密切关系,抵抗素分泌增多可能是发生胰岛素抵抗的原因之一。 2、抵抗素可能参与了冠状动脉狭窄的形成,空腹血清的抵抗素水平有望成为衡量冠心病患者冠脉狭窄程度的预测因子。
Background and Objective Cardiovascular disease is the first fatal disease in the world. So, it is gotten more and more attention in the medical science. The research of coronary heart disease (CHD)which is the multi-etiological factors disease is also more and more hot. Insulin resistance(IR) is the importance etiological factor of CHD. When resistin(RSTN) is founded,one new road is gotten in the research of etiological factor of CHD . In the past research of relationship between serum RSTN level with IR,there were two completely different results. One is serum RSTN level correlate with IR. The other one is serum RSTN level unrelate with IR. The relationship between serum RSTN level with severity of artherosclerosis have gotten two completely different results too. The purpose of present study are as follows: 1.to investigate the relationship between serum RSTN level with IR; 2. to investigate the relationship between serum RSTN level with severity of coronary artherosclerosis. Methods 1.There have 57 patients with CHD which accept coronary arteriography successfully from November,2005 to April,2006. According to the result of coronary arteriography, The 57 patients were divided into two group , experimental group-the level of stenosis≥50%(n=45)and control group-the level of stenosis<50%(n=12). Remove stand: the patients have liver disease、kidney disease、pancreas disease and thyroid disease. 2. General state of health:sex, age, body height, body mass, body mass index(BMI). 3. Fasting plasma glucose(FPG) and Fasting serum RSTN (FSR) in 57 patients were assayed by were assayed by enzyme-linked immunoassay. Fasting serum insulin(FSI) were assayed by radioimmunoassay. 4. The severity of coronary artery atherosclerosis was quantified with a modified Gensini score on the basis of angiographic imaging. 5.All data are analyzed SPSS10.0 Results 1.FSI、modulus of ISI and FSR in the patients with CHD were found significantly higher than in control group(P<0.01). 2.The patients with CHD show a positive correlation between serum RSTN and FSI, (r=0.303,P<0.05), FSR related significant positively with the Gensini score of coronary stenosis, (r=0.38,P=0.01).FSR related negatively with ISI,(r=-0.296,P<0.05). 3.The serum RSTN was a independence influencing factor to the Gensini score of coronary stenosis(R2=0.224,P=0.01)and FSI(R2=0.120,P<0.05). Conclusion 1.FSR level in the patients with CHD correlate positively with IR.The hyperesistinmia maybe is one cause of IR. 2.RSTN maybe participate in coronary artery stenosis. The level of FSR may be beneficial to predict the severity of coronary artherosclerosis.
|
