Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Diab Vasc Dis Res. 2011 Jan;8(1):35-42. doi: 10.1177/1479164110396744.
The relationship between insulin secretion and acute insulin resistance (as assessed by Homeostatic Model Assessment [HOMA] index) and clinical and biochemical parameters in the early phase of non-diabetic ST-elevation myocardial infarction (STEMI) is so far unexplored. We aimed at assessing this relation in 286 consecutive STEMI patients without previously known diabetes submitted to primary percutaneous coronary intervention (PCI). Insulin resistance (as indicated by HOMA) was detectable in 67.1%. Non-parametric correlation showed that HOMA index was significantly correlated with BMI (r = 0.242; p < 0.0001) and HbA(1c) (r = 0.189; p < 0.001). At multivariable backward linear regression analysis, glycaemia was directly related to leukocyte count (p = 0.0003), age (p = 0.0001), creatine kinase isoform MB (CK-MB) (p = 0.00278) and lactate (p < 0.0001). Insulin was directly and significantly related to glycaemia (p = 0.0006), body mass index (BMI) (p = 0.00028) and lactate (p = 0.0096) In the early phase of STEMI without previously known diabetes the acute glucose dysmetabolism is quite complex, comprising increased glucose values and the development of acute insulin resistance. While insulin secretion is strictly related to BMI, apart from glucose levels, increased glucose values can be mainly related to the acute inflammatory response (as indicated to leukocyte count and C-RP), to age and to the degree of myocardial damage (as inferred by CK-MB).
在非糖尿病性 ST 段抬高型心肌梗死（STEMI）的早期阶段，胰岛素分泌与急性胰岛素抵抗（通过稳态模型评估[HOMA]指数评估）以及临床和生化参数之间的关系尚未得到探索。我们旨在评估 286 例连续 STEMI 患者在未预先知晓糖尿病的情况下进行经皮冠状动脉介入治疗（PCI）的这种关系。胰岛素抵抗（如 HOMA 所示）可检测到 67.1%。非参数相关性表明，HOMA 指数与 BMI（r = 0.242；p < 0.0001）和 HbA（1c）（r = 0.189；p < 0.001）显著相关。在多变量向后线性回归分析中，血糖直接与白细胞计数（p = 0.0003）、年龄（p = 0.0001）、肌酸激酶同工酶 MB（CK-MB）（p = 0.00278）和乳酸（p < 0.0001）相关。胰岛素与血糖（p = 0.0006）、体重指数（BMI）（p = 0.00028）和乳酸（p = 0.0096）直接且显著相关。在无先前已知糖尿病的 STEMI 早期阶段，急性葡萄糖代谢紊乱相当复杂，包括血糖升高和急性胰岛素抵抗的发展。虽然胰岛素分泌与 BMI 密切相关，但除了血糖水平外，血糖升高可能主要与急性炎症反应（如白细胞计数和 C-RP 所示）、年龄和心肌损伤程度（如 CK-MB 推断）有关。
