Job F P, Wolfertz J, Meyer R, Hübinger A, Gries F A, Kuhn H
Bielefeld Medical Clinic II, Department of Cardiology, Städt. Krankenanstalten Bielefeld Mitte, Germany.
Coron Artery Dis. 1994 Jun;5(6):487-92.
To assess the clinical impact of hyperinsulinism and major coronary risk factors in patients with angiographically documented or excluded coronary artery disease (CAD), a clinical study was carried out in 268 men admitted for left heart catheterization.
Fasting immunoreactive insulin (IRI) levels were correlated to all major cardiovascular risk factors and to the presence and degree of CAD.
IRI levels were correlated significantly with the degree of CAD (one-vessel disease: mean IRI 9.45 microU/ml +/- 0.43 SEM; two-vessel disease: mean IRI 10.4 microU/ml +/- 0.71 SEM; three-vessel disease: mean IRI 11.88 microU/ml +/- 0.98 SEM) and inversely to the high-density lipoprotein level (P < 0.05). In patients with arterial hypertension, IRI levels were elevated, without a significant difference between those with and those without CAD, whereas the IRI levels of non-hypertensive men with CAD (n = 81; mean IRI 9.85 microU/ml +/- 0.51 SEM) differed significantly (P < 0.05) from those of non-hypertensive men without CAD (n = 59; mean IRI 7.76 microU/ml +/- 0.43 SEM). IRI levels were significantly higher (P < 0.05) in obese patients (n = 65; mean IRI 11.68 microU/ml +/- 0.70 SEM versus n = 203; mean IRI 9.32 microU/ml +/- 0.34 SEM), in patients with elevated triglycerides (n = 58 mean IRI 11.59 microU/ml +/- 0.81 SEM versus n = 210; mean IRI 9.42 microU/ml +/- 0.33 SEM), and in patients with lowered HDL cholesterol (n = 178; mean IRI 11.06 microU/ml +/- 0.63 SEM versus n = 90; mean IRI 9.29 microU/ml +/- 0.34 SEM). Diabetic patients on angiotensin converting enzyme inhibitor therapy (n = 11; mean IRI 7.91 microU/ml +/- 0.91 SEM) had significantly (P < 0.05) lower IRI levels than those not treated with ACE inhibitors (n = 25; mean IRI 12.96 microU/ml +/- 1.47 SEM). IRI levels exceeding 8 microU/ml were associated with a 1.98-fold risk for CAD compared with IRI levels below 8 microU/ml. Stepwise logistic regression showed that insulin was an independent determinant of CAD.
Knowledge of the fasting insulin level is an important contribution to the identification of patients with, or at risk of, CAD.
为评估高胰岛素血症及主要冠心病危险因素对经血管造影证实或排除冠心病（CAD）患者的临床影响，对268名因行左心导管插入术而入院的男性患者进行了一项临床研究。
将空腹免疫反应性胰岛素（IRI）水平与所有主要心血管危险因素以及CAD的存在和程度进行关联分析。
IRI水平与CAD程度显著相关（单支血管病变：平均IRI 9.45微单位/毫升±0.43标准误；双支血管病变：平均IRI 10.4微单位/毫升±0.71标准误；三支血管病变：平均IRI 11.88微单位/毫升±0.98标准误），且与高密度脂蛋白水平呈负相关（P<0.05）。在高血压患者中，IRI水平升高，患CAD和未患CAD者之间无显著差异，而患CAD的非高血压男性（n = 81；平均IRI 9.85微单位/毫升±0.51标准误）与未患CAD的非高血压男性（n = 59；平均IRI 7.76微单位/毫升±0.43标准误）的IRI水平差异显著（P<0.05）。肥胖患者（n = 65；平均IRI 11.68微单位/毫升±0.70标准误对比n = 203；平均IRI 9.32微单位/毫升±0.34标准误）、甘油三酯升高患者（n = 58，平均IRI 11.59微单位/毫升±0.81标准误对比n = 210；平均IRI 9.42微单位/毫升±0.33标准误）以及高密度脂蛋白胆固醇降低患者（n = 178；平均IRI 11.06微单位/毫升±0.63标准误对比n = 90；平均IRI 9.29微单位/毫升±0.34标准误）的IRI水平显著更高（P<0.05）。接受血管紧张素转换酶抑制剂治疗的糖尿病患者（n = 11；平均IRI 7.91微单位/毫升±0.91标准误）的IRI水平显著低于未接受血管紧张素转换酶抑制剂治疗的患者（n = 25；平均IRI 12.96微单位/毫升±1.47标准误）（P<0.05）。与IRI水平低于8微单位/毫升相比，IRI水平超过8微单位/毫升时患CAD的风险增加1.98倍。逐步逻辑回归分析表明胰岛素是CAD的独立决定因素。
了解空腹胰岛素水平对识别CAD患者或有CAD风险的患者具有重要意义。
