胰岛素输注进行严格代谢控制对糖尿病患者急性冠脉事件期间纤溶状态的作用。
The role of strict metabolic control by insulin infusion on fibrinolytic profile during an acute coronary event in diabetic patients.
作者信息
Melidonis A, Stefanidis A, Tournis S, Manoussakis S, Handanis S, Zairis M, Dadiotis L, Foussas S
机构信息
Diabetic Department, Tzanio Hospital, Piraeus, Greece.
出版信息
Clin Cardiol. 2000 Mar;23(3):160-4. doi: 10.1002/clc.4960230306.
BACKGROUND
Many clinical and laboratory observations give support to the hypothesis that strict metabolic control by insulin infusion during acute coronary events may improve the ischemic damage and prognosis.
HYPOTHESIS
We investigated the impact of intensive insulin treatment on fibrinolytic parameters during an acute ischemic myocardial event (unstable angina or acute myocardial infarction) in patients with type 2 diabetes mellitus.
METHODS
The study group consisted of 48 type 2 diabetic patients, of whom 24 were randomized to conventional therapy plus intensive insulin treatment (Group 1) and 24 to conventional therapy only (Group 2). The two groups were comparable according to gender, age, body mass index, waist:hip ratio, duration of diabetes, previous antidiabetic treatment, type of ischemic events, concomitant therapy, and the classic risk factors for coronary disease. Insulin-treated patients were excluded from the study. Plasma levels of fibrinogen, tissue plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) were measured on admission and discharge. Fibrinogen (fibr) was measured using the photometric method. PAI-1 and t-PA were measured by enzyme-linked immunosorbent assays.
RESULTS
T-PA increased in both groups during hospitalization (t-PA(admission) vs. t-PA(discharge): Group 1: 15.42 +/- 4.4 ng x ml(-1) vs. 21.2 +/- 5.74 ng x ml(-1), p = 0.000037; Group 2: 14.47 +/- 6.31 ng x ml(-1) vs. 19.18 +/- 6.88 ng x ml(-1), p = 0.001). On the other hand, fibr and PAI-1 levels increased remarkably in controls (Group 2, fibr(admission) vs. fibr(discharge): 2.98 +/- 1.04 g x l(-1) vs. 3.59 +/- 1.01 g x l(-1), p = 0.002, and PAI-1admission vs. PAI-1 discharge: 30.6 +/- 17.34 ng x ml(-1) vs. 40.62 +/- 23.48 ng x ml(-1), p = 0.003). This finding was not observed in the intensive insulin treatment group (Group 1, fibr(admission) vs. fibr(discharge): 2.87 +/- 0.73 g x l(-1) vs. 2.67 +/- 0.72 g x l(-1), p = 0.101, and PAI-1 admission vs. PAI-1 discharge: 30.75 +/- 15.81 ng x ml(-1) vs. 27.75 +/- 6.43 ng x ml(-1), p = 0.484).
CONCLUSION
Intensive insulin treatment during an acute coronary event improves fibrinolytic profile in patients with diabetes mellitus. This is a possible mechanism for the reduced short- and long-term mortality in diabetic patients treated with intensive insulin treatment protocol.
背景
许多临床和实验室观察结果支持这样一种假说，即在急性冠脉事件期间通过胰岛素输注进行严格的代谢控制可能改善缺血性损伤和预后。
假说
我们研究了强化胰岛素治疗对2型糖尿病患者急性缺血性心肌事件（不稳定型心绞痛或急性心肌梗死）期间纤溶参数的影响。
方法
研究组由48例2型糖尿病患者组成，其中24例随机分配至常规治疗加强化胰岛素治疗组（第1组），24例仅接受常规治疗（第2组）。两组在性别、年龄、体重指数、腰臀比、糖尿病病程、既往抗糖尿病治疗、缺血事件类型、伴随治疗以及冠心病的经典危险因素方面具有可比性。排除接受胰岛素治疗的患者。在入院时和出院时测量血浆纤维蛋白原、组织型纤溶酶原激活物（t-PA）和纤溶酶原激活物抑制剂-1（PAI-1）水平。纤维蛋白原（fibr）采用光度法测量。PAI-1和t-PA通过酶联免疫吸附测定法测量。
结果
住院期间两组的t-PA均升高（t-PA（入院）与t-PA（出院）：第1组：15.42±4.4 ng·ml⁻¹ 与21.2±5.74 ng·ml⁻¹，p = 0.000037；第2组：14.47±6.31 ng·ml⁻¹ 与19.18±6.88 ng·ml⁻¹，p = 0.001）。另一方面，对照组（第2组）的fibr和PAI-1水平显著升高（fibr（入院）与fibr（出院）：2.98±1.04 g·L⁻¹ 与3.59±1.01 g·L⁻¹，p = 0.002，以及PAI-1（入院）与PAI-1（出院）：30.6±17.34 ng·ml⁻¹ 与40.62±23.48 ng·ml⁻¹，p = 0.003）。在强化胰岛素治疗组（第1组）未观察到这一发现（fibr（入院）与fibr（出院）：2.87±0.73 g·L⁻¹ 与2.67±0.72 g·L⁻¹，p = 0.101，以及PAI-1（入院）与PAI-1（出院）：30.75±15.81 ng·ml⁻¹ 与27.75±6.43 ng·ml⁻¹，p = 0.484）。
结论
急性冠脉事件期间的强化胰岛素治疗可改善糖尿病患者的纤溶状态。这是接受强化胰岛素治疗方案的糖尿病患者短期和长期死亡率降低的一种可能机制。
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