Nishio Kazuaki, Shigemitsu Meiei, Kusuyama Taro, Fukui Tomoyasu, Kawamura Kitaro, Itoh Seiji, Konno Noburu, Katagiri Takashi
The Third Department of Internal Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Tokyo 142-8666, Japan.
Cardiovasc Revasc Med. 2006 Apr-Jun;7(2):54-60. doi: 10.1016/j.carrev.2005.12.004.
Recent studies have shown that insulin resistance (IR) is an independent predictor of early restenosis after coronary stenting. The aim of this study was to examine the effects of IR and its linkage to late loss with bare metal stenting in nondiabetic patients with acute myocardial infarction (AMI).
We enrolled 61 nondiabetic patients with AMI who have undergone coronary stenting. Quantitative analyses of coronary angiographic data before and after the procedure and at 4 months were performed. Fasting plasma glucose (FPG) and insulin were measured every week until the subjects' hospital discharge. Stress hormones, endothelial nitric oxide synthase, tumor necrosis factor alpha, interleukin-6, leptin, and adiponectin were measured on admission and at 4 months after coronary stenting.
Simple linear regression analyses showed a relationship between FPG and insulin [IR group: r=0.297, P=.0428; no insulin resistance (NIR) group: r=0.539, P=.0466] and that late loss was associated with the homeostasis model assessment of IR (HOMA-IR) at 4 months (r=0.435, P=.03). At multiple regression analyses, HOMA-IR on admission in the IR group significantly correlated with thyroid-stimulating hormone, glucagon, and cortisol. The HOMA-IR at 4 months correlated with leptin.
Nondiabetic patients with AMI can be classified into two groups: the IR group and the NIR group. The IR consisted of the transient IR, which correlated with stress hormones, and the continuous IR, which correlated with leptin and contributed to restenosis after coronary stenting.
近期研究表明，胰岛素抵抗（IR）是冠状动脉支架置入术后早期再狭窄的独立预测因素。本研究旨在探讨IR对非糖尿病急性心肌梗死（AMI）患者裸金属支架置入术后的影响及其与晚期管腔丢失的关系。
我们纳入了61例接受冠状动脉支架置入术的非糖尿病AMI患者。对手术前后及术后4个月的冠状动脉造影数据进行定量分析。每周测量空腹血糖（FPG）和胰岛素水平，直至患者出院。在入院时及冠状动脉支架置入术后4个月测量应激激素、内皮型一氧化氮合酶、肿瘤坏死因子α、白细胞介素-6、瘦素和脂联素。
简单线性回归分析显示FPG与胰岛素之间存在相关性[IR组：r = 0.297，P = 0.0428；无胰岛素抵抗（NIR）组：r = 0.539，P = 0.0466]，且晚期管腔丢失与术后4个月的胰岛素抵抗稳态模型评估（HOMA-IR）相关（r = 0.435，P = 0.03）。在多元回归分析中，IR组入院时的HOMA-IR与促甲状腺激素、胰高血糖素和皮质醇显著相关。术后4个月的HOMA-IR与瘦素相关。
非糖尿病AMI患者可分为两组：IR组和NIR组。IR包括与应激激素相关的短暂性IR和与瘦素相关并导致冠状动脉支架置入术后再狭窄的持续性IR。
