Zou Xiaoyi, Chen Ming, Sun Limin, Tan Qiang
Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, Hebei Province, People's Republic of China.
Diabetes Metab Syndr Obes. 2023 May 18;16:1425-1433. doi: 10.2147/DMSO.S402849. eCollection 2023.
Hyperinsulinemia impaired cardiovascular system and endothelial function in the population. The purpose of this study was to explore the relationship between hyperinsulinemia and coronary collateral circulation in patients with chronic total coronary occlusion.
Patients with stable angina and at least one total coronary occlusion were enrolled in this study. Collateral grade was determined according to Rentrop's classification. Patients were divided into a good coronary collateral circulation (CCC) group (grade 2 or 3 collateral vessels, n = 223) and a poor CCC group (grade 0 or 1 collateral vessels, n = 115). Fasting insulin level (FINS) and fasting glucose level (FBS) were measured. Endothelial function evaluated by flow-mediated dilation (FMD).
Serum FINS level was significantly increased in the poor CCC group ( < 0.01). Patients in the poor CCC group had higher levels of FBS, HbA1C, and homeostasis model assessment for insulin resistance (HOMA-IR) than patients in the good CCC group. The poor CCC group also had lower levels of FMD, lower LVEF and higher syntax scores than the good CCC group. Hyperinsulinemia (T3, FINS ≥15.22 μIU/mL) increased OR for the incidence of the poor CCC group (OR 2.419, 95% CI 1.780-3.287) in multivariate analysis. Multivariate logistic regression also revealed that diabetes, HbA1c, HOMA-IR, HDL-C and Syntax score were independent predictors of poor CCC (all P < 0.05).
Hyperinsulinemia is a valuable predictor of poor collateral formation in patients with chronic total coronary occlusion.
高胰岛素血症会损害人群的心血管系统和内皮功能。本研究旨在探讨慢性冠状动脉完全闭塞患者高胰岛素血症与冠状动脉侧支循环之间的关系。
纳入患有稳定型心绞痛且至少有一处冠状动脉完全闭塞的患者。根据Rentrop分级确定侧支等级。患者被分为冠状动脉侧支循环良好（CCC）组（2级或3级侧支血管，n = 223）和CCC不良组（0级或1级侧支血管，n = 115）。测量空腹胰岛素水平（FINS）和空腹血糖水平（FBS）。通过血流介导的血管舒张（FMD）评估内皮功能。
CCC不良组血清FINS水平显著升高（<0.01）。CCC不良组患者的FBS、糖化血红蛋白（HbA1C）水平以及胰岛素抵抗稳态模型评估（HOMA-IR）均高于CCC良好组患者。CCC不良组的FMD水平、左心室射血分数（LVEF）较低，且句法评分高于CCC良好组。在多变量分析中，高胰岛素血症（T3，FINS≥15.22 μIU/mL）增加了CCC不良组发病的比值比（OR 2.419，95%可信区间1.780 - 3.287）。多变量逻辑回归还显示，糖尿病、HbA1c、HOMA-IR、高密度脂蛋白胆固醇（HDL-C）和句法评分是CCC不良的独立预测因素（均P < 0.05）。
高胰岛素血症是慢性冠状动脉完全闭塞患者侧支形成不良的一个有价值的预测指标。
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