Lazzeri Chiara, Valente Serafina, Chiostri Marco, Attanà Paola, Mattesini Alessio, Gensini Gian Franco
Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Angiology. 2014 Jul;65(6):519-24. doi: 10.1177/0003319713489018. Epub 2013 May 6.
We assessed the incidence and the prognostic role for early death of acute insulin resistance (by means of homeostatic model assessment [HOMA] index) in 1350 patients with acute coronary syndrome (ACS) consecutively admitted to our intensive cardiac care unit (ICCU). The incidence of HOMA positivity was 5% (68 of 1350), with the highest percentage of HOMA positivity among ST-segment elevation myocardial infarction (STEMI). Patients with HOMA positivity showed a higher body mass index (P = .003), lower values of admission and discharge left-ventricular ejection fraction (LVEF; P < .001 and P = .003, respectively), and higher levels of peak troponin I (Tn I; P < .001). The HOMA index was an independent predictor of early death (odds ratio 1.724, 95% confidence interval 1.252-2.375, P = .001). In patients with ACS and without previously known diabetes, acute insulin resistance (HOMA index) is associated with a larger myocardial damage (ie, higher values of peak Tn I and lower LVEF) and a greater inflammatory activation (indicated by correlation with leukocyte count). The HOMA positivity was an independent predictor of in-ICCU mortality.
我们对连续入住我院重症心脏监护病房（ICCU）的1350例急性冠状动脉综合征（ACS）患者，评估了急性胰岛素抵抗（通过稳态模型评估[HOMA]指数）的发生率及其对早期死亡的预后作用。HOMA阳性发生率为5%（1350例中的68例），其中ST段抬高型心肌梗死（STEMI）患者中HOMA阳性率最高。HOMA阳性患者的体重指数较高（P = 0.003），入院和出院时左心室射血分数（LVEF）值较低（分别为P < 0.001和P = 0.003），肌钙蛋白I峰值（Tn I）水平较高（P < 0.001）。HOMA指数是早期死亡的独立预测因素（比值比1.724，95%置信区间1.252 - 2.375，P = 0.001）。在既往无糖尿病的ACS患者中，急性胰岛素抵抗（HOMA指数）与更大的心肌损伤（即Tn I峰值更高、LVEF更低）和更强的炎症激活相关（与白细胞计数的相关性表明）。HOMA阳性是ICCU内死亡率的独立预测因素。
