Rabbani L E, Edelman E R, Ganz P, Selwyn A P, Loscalzo J, Bittl J A
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115.
Am J Cardiol. 1994 Feb 15;73(5):323-7. doi: 10.1016/0002-9149(94)90002-7.
Several studies have shown that diabetes mellitus increases the risk of restenosis after coronary intervention, but the role of insulin in restenosis has not been defined. The relation between fasting insulin levels and restenosis was evaluated prospectively at 6-month angiographic follow-up in 70 patients undergoing excimer laser coronary angioplasty of 75 lesions. Restenosis (> 50% diameter narrowing on quantitative angiography) was observed at 37 of 75 treated sites (49%). Although patients with glucose intolerance and noninsulin-dependent diabetes mellitus showed a trend toward increased restenosis (restenosis rate 69%; odds ratio for restenosis 2.7 [95% confidence interval 0.76, 9.82]; p = 0.124), those with increased fasting insulin levels > 15 muU/ml had reduced restenosis (restenosis rate 24%; odds ratio 0.22 [0.07, 0.67]; p = 0.008). Other factors including fasting serum glucose, glycated hemoglobin and lipoprotein fraction were not predictive of restenosis. The relation between insulin levels and restenosis after excimer laser angioplasty may provide insights into the biology of vascular injury and repair after coronary intervention.
多项研究表明，糖尿病会增加冠状动脉介入术后再狭窄的风险，但胰岛素在再狭窄中的作用尚未明确。在70例接受准分子激光冠状动脉成形术治疗75处病变的患者中，于6个月血管造影随访时对空腹胰岛素水平与再狭窄之间的关系进行了前瞻性评估。在75处治疗部位中的37处（49%）观察到再狭窄（定量血管造影显示直径狭窄>50%）。尽管糖耐量异常和非胰岛素依赖型糖尿病患者有再狭窄增加的趋势（再狭窄率69%；再狭窄比值比为2.7[95%置信区间0.76, 9.82]；p = 0.124），但空腹胰岛素水平>15 muU/ml的患者再狭窄减少（再狭窄率24%；比值比0.22[0.07, 0.67]；p = 0.008）。包括空腹血糖、糖化血红蛋白和脂蛋白组分在内的其他因素并不能预测再狭窄。准分子激光血管成形术后胰岛素水平与再狭窄之间的关系可能有助于深入了解冠状动脉介入术后血管损伤和修复的生物学机制。
