Liang Kae-Woei, Sheu Wayne H-H, Lee Wen-Jane, Lee Wen-Lieng, Pan Hung-Chih, Lee I-Te, Wang Jun-Sing
Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan.
School of Medicine, National Yang Ming University, Taipei, Taiwan.
Diabetol Metab Syndr. 2017 Feb 8;9:10. doi: 10.1186/s13098-017-0209-1. eCollection 2017.
Cardiac syndrome X (CSX) is characterized by angina pectoris but with patent coronary arteries. Our previous study demonstrated that subjects with CSX had a higher fasting insulin-resistance (IR) than the controls. However, few studies have investigated the degree of IR, including oral glucose tolerance test (OGTT)-derived indices and profiles of metabolic abnormalities between CSX and coronary artery disease (CAD).
Ninety-two CSX and 145 CAD subjects without known diabetes mellitus (DM) underwent coronary angiogram (CAG) for angina pectoris and also agreed to receive OGTT and glycated hemoglobin (HbA) evaluations for screening abnormal glucose regulation and IR.
CAD group had more subjects with metabolically unhealthy obesity (52.4 vs. 31.5%, p < 0.001) than the CSX group. The CAD group had higher OGTT 2 h glucose and insulin (both p < 0.005) while fasting glucose, insulin and HOMA-IR were similar to those of CSX subjects. In the binary regression analysis, OGTT 2 h insulin and being metabolic unhealthy were significantly different between the CAD and CSX groups, but there were no significant differences in Matsuda index, fasting glucose, insulin, HOMA-IR, or HbA.
Post challenge OGTT 2 h insulin and being metabolic unhealthy were useful parameters in differentiating between CAD and CSX in subjects without known DM but suffered from angina pectoris and underwent CAG. Different degrees of IR and metabolic abnormalities might be implicated in the pathogenesis of micro vs. macro vascular coronary diseases. NCT01198730 at https://clinicaltrials.gov, Registered Sep. 8, 2010.
心脏综合征X（CSX）的特征为心绞痛但冠状动脉通畅。我们之前的研究表明，CSX患者的空腹胰岛素抵抗（IR）高于对照组。然而，很少有研究调查CSX与冠状动脉疾病（CAD）之间IR的程度，包括口服葡萄糖耐量试验（OGTT）得出的指标以及代谢异常情况。
92例CSX患者和145例无糖尿病（DM）的CAD患者因心绞痛接受了冠状动脉造影（CAG），并同意接受OGTT和糖化血红蛋白（HbA）评估以筛查异常葡萄糖调节和IR。
CAD组代谢不健康肥胖的患者比CSX组更多（52.4%对31.5%，p<0.001）。CAD组的OGTT 2小时血糖和胰岛素水平更高（均p<0.005），而空腹血糖、胰岛素和稳态模型评估胰岛素抵抗（HOMA-IR）与CSX患者相似。在二元回归分析中，CAD组和CSX组之间OGTT 2小时胰岛素和代谢不健康情况存在显著差异，但在松田指数、空腹血糖、胰岛素、HOMA-IR或HbA方面无显著差异。
在无已知DM但有心绞痛且接受CAG的患者中，OGTT激发后2小时胰岛素和代谢不健康情况是区分CAD和CSX的有用参数。不同程度的IR和代谢异常可能与微血管和大血管冠状动脉疾病的发病机制有关。https://clinicaltrials.gov上的NCT01198730，于2010年9月8日注册。
