胰岛素抵抗的心肌梗死患者的血脂、脂肪因子和胃饥饿素水平。
Lipid, adipokine and ghrelin levels in myocardial infarction patients with insulin resistance.
机构信息
Research Institute for Complex Issues of Cardiovascular Diseases under the Siberian Branch of the Russian Academy of Medical Sciences, Kemerovo, Russia.
出版信息
BMC Cardiovasc Disord. 2014 Jan 16;14:7. doi: 10.1186/1471-2261-14-7.
BACKGROUND
Insulin resistance (IR) is a risk factor for ischaemic heart disease and myocardial infarction (MI). IR often manifests in MI and is regarded as an independent predictor of in-hospital mortality, which can provide early risk stratification for recurrent acute coronary events.
METHODS
The study enrolled 200 patients (130 males and 70 females aged 61.4 ± 1.12 years) diagnosed with ST elevation MI. At days 1 and 12 from the MI onset, IR levels and lipid profiles, as well as serum glucose, insulin, adipokine and ghrelin levels, were measured.
RESULTS
Free fatty acid (FFA) levels had the most pronounced changes: IR patients had a 9-fold increase in FFA levels at day 1, and patients without IR had a 6-fold increase. Leptin levels at days 1 and 12, in IR patients were, on average, 1.5- and 2-fold higher compared to the controls and patients with no IR (р < 0.05). Leptin levels in IR patients were increased throughout the entire hospital stay. Resistin levels in IR patients were, on average, 1.4-fold higher throughout the entire hospital stay, while in non-IR patients, resistin levels were similar to the controls. Adiponectin levels in IR patients were decreased compared to the controls, while in patients with IR, they were similar to the controls. Both IR and non-IR MI patients had 3-fold and 3.7-fold lower ghrelin levels at day 1, respectively, compared to the controls. The correlation analysis showed a negative correlation between ghrelin and FFA (r = -0.48 р = 0.007), ghrelin and leptin (r = -0.4 р = 0.003), ghrelin and insulin (r = -0.54 р = 0.002), and ghrelin and glucose (r = -0.31 р = 0.002) in MI patients.
CONCLUSION
Dyslipidaemia, along with insulinaemia and glycaemia, is one of the most significant IR risk factors in the acute and early recovery phases of MI. Dyslipidaemia is characterised by a high FFA level; an imbalance of leptin, resistin, and adiponectin; and a deficiency of ghrelin in the acute and early recovery periods of MI. FFA and ghrelin can be used as promising molecular markers to stratify the risk of recurrent acute coronary events and diabetes mellitus in MI patients.
背景
胰岛素抵抗（IR）是缺血性心脏病和心肌梗死（MI）的危险因素。IR 常表现为 MI，并被视为院内死亡率的独立预测因素，可提供复发性急性冠状动脉事件的早期风险分层。
方法
本研究纳入了 200 名患者（130 名男性和 70 名女性，年龄 61.4±1.12 岁），这些患者被诊断为 ST 段抬高型 MI。在 MI 发病后的第 1 天和第 12 天，测量了 IR 水平和血脂谱以及血清葡萄糖、胰岛素、脂肪因子和 ghrelin 水平。
结果
游离脂肪酸（FFA）水平的变化最为显著：IR 患者在第 1 天的 FFA 水平增加了 9 倍，而无 IR 患者的 FFA 水平增加了 6 倍。IR 患者在第 1 天和第 12 天的瘦素水平平均比对照组和无 IR 患者高 1.5-2 倍（p<0.05）。IR 患者的瘦素水平在整个住院期间均升高。IR 患者的抵抗素水平在整个住院期间平均升高 1.4 倍，而非 IR 患者的抵抗素水平与对照组相似。IR 患者的脂联素水平低于对照组，而 IR 患者的脂联素水平与对照组相似。IR 和非 IR MI 患者在第 1 天的 ghrelin 水平分别比对照组低 3 倍和 3.7 倍。相关性分析显示，MI 患者的 ghrelin 与 FFA（r=-0.48，p=0.007）、ghrelin 与 leptin（r=-0.4，p=0.003）、ghrelin 与胰岛素（r=-0.54，p=0.002）和 ghrelin 与葡萄糖（r=-0.31，p=0.002）之间呈负相关。
结论
血脂异常，以及胰岛素血症和高血糖症，是 MI 急性和早期恢复期胰岛素抵抗的最重要危险因素之一。血脂异常的特征是高水平的游离脂肪酸；leptin、resistin 和脂联素的失衡；以及 MI 急性和早期恢复期 ghrelin 的缺乏。FFA 和 ghrelin 可作为有前途的分子标志物，用于 MI 患者复发性急性冠状动脉事件和糖尿病的风险分层。
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