Komatsu Takaaki, Yaguchi Isao, Komatsu Sachiko, Nakahara Shiro, Kobayashi Sayuki, Sakai Yoshihiko, Taguchi Isao
Tex Heart Inst J. 2015 Aug 1;42(4):327-32. doi: 10.14503/THIJ-14-4393. eCollection 2015 Aug.
Percutaneous coronary intervention is established as an effective treatment for patients with ischemic heart disease; in particular, drug-eluting stent implantation is known to suppress in-stent restenosis. Diabetes mellitus is an independent risk factor for restenosis, so reducing insulin resistance is being studied as a new treatment approach. In this prospective study, we sought to clarify the factors associated with in-stent restenosis after percutaneous coronary intervention, and we evaluated the homeostasis model assessment of insulin resistance (HOMA-IR) index as a predictor of restenosis. We enrolled 136 consecutive patients who underwent elective percutaneous coronary intervention at our hospital from February 2010 through April 2013. All were implanted with a 2nd-generation drug-eluting stent. We distributed the patients in accordance with their HOMA-IR index values into insulin-resistant Group P (HOMA-IR, ≥2.5; n=77) and noninsulin-resistant Group N (HOMA-IR, <2.5; n=59). Before and immediately after stenting, we measured reference diameter, minimal lumen diameter, and percentage of stenosis, and after 8 months we measured the last 2 factors and late lumen loss, all by means of quantitative coronary angiography. After 8 months, the mean minimal lumen diameter was smaller in Group P than that in Group N (1.85 ± 1.02 vs 2.37 ± 0.66 mm; P=0.037), and the mean late lumen loss was larger (0.4 ± 0.48 vs 0.16 ± 0.21 mm; P=0.025). These results suggest that insulin resistance affects neointimal tissue proliferation after 2nd-generation drug-eluting stent implantation.
经皮冠状动脉介入治疗已被确立为缺血性心脏病患者的有效治疗方法；特别是，药物洗脱支架植入术已知可抑制支架内再狭窄。糖尿病是再狭窄的独立危险因素，因此降低胰岛素抵抗正作为一种新的治疗方法进行研究。在这项前瞻性研究中，我们试图阐明经皮冠状动脉介入治疗后与支架内再狭窄相关的因素，并评估胰岛素抵抗的稳态模型评估（HOMA-IR）指数作为再狭窄的预测指标。我们纳入了2010年2月至2013年4月在我院连续接受择期经皮冠状动脉介入治疗的136例患者。所有患者均植入第二代药物洗脱支架。我们根据患者的HOMA-IR指数值将其分为胰岛素抵抗组P（HOMA-IR≥2.5；n=77）和非胰岛素抵抗组N（HOMA-IR<2.5；n=59）。在支架置入前和置入后即刻，我们通过定量冠状动脉造影测量参考直径、最小管腔直径和狭窄百分比，在8个月后我们测量后两个因素和晚期管腔丢失。8个月后，P组的平均最小管腔直径小于N组（1.85±1.02 vs 2.37±0.66 mm；P=0.037），平均晚期管腔丢失更大（0.4±0.48 vs 0.16±0.21 mm；P=0.025）。这些结果表明，胰岛素抵抗会影响第二代药物洗脱支架植入术后的新生内膜组织增殖。
