观察尿微量白蛋白和胰岛素抵抗与2型糖尿病患者冠状动脉硬化的关系

摘要

Objective: :Micaoalbuninuria is a sensitive index of early stage of diabetic nephropathy, and insulin resistance as a character of type 2 diabetes is one of a risk factor of macrovascular complictions of diabetes. In the study, we observe the relations among microalbuninuria, insulin resistance and coronary atherosclerosis in adult type 2 diabetes.Methods:100 type 2 diabetes com-pany with coronary heart disease were enrolled in the study. According to the value of urine albumin/creatinine, the subjects were di-vided into two groups, type 2 diabetes with microalbuninuria and type 2 diabetes without microalbuninuria, Fasting plasma glucose and insulin were assayed to all patients. Insulin sensitivity index (ISI) and insulin resistance index (HOMA-IR) were calculated. Selective Judkins coronary angiography was used to appraise the severity of coronary atherosclerosis. The number of lesion branches, coronary stenosis index and diffuse lesions were observed. Results:Insulin resistance index(HOMA-IR) increased significantly in the group of type 2 diabetes with microalbuminuria than those without microalbuminuria (P<0.05). In the group of type 2 diabetes with microalbu-minuria, as the number of lesion branches increasing, the level of microalbuminuria and insulin resistance index increased (P<0.01). Conclusion:The data suggested that microalbuminuria and insulin resistance were positively correlated to the seversity of coronary atherosclerosis. Moreover, combination of the assay of microalbuminuria and insulin resistance were sensitive predictor of the severity of coronary atherosclerosis.%目的：微量蛋白尿是2型糖尿病合并肾病发生的早期临床标志，而胰岛素抵抗是2型糖尿病的特征性改变，与大血管合并症的发生密切相关。本研究观察2型糖尿病患者尿微量白蛋白和胰岛素抵抗与冠脉粥样硬化风险的关系。方法：选取2013年2月至2014年3月入住于“黑龙江省农垦总局总医院”心内科的2型糖尿病合并冠心病的患者100例。按照尿微量白蛋白/肌酐的数值分为两组，2型糖尿病不伴尿微量白蛋白组50例，2型糖尿病伴尿微量白蛋白50例。所有患者均测定空腹血浆血糖（FBG）和血浆胰岛素(FINS)水平，计算胰岛素敏感性指数和胰岛素抵抗指数（HOMA-IR）。选用Judkins法行选择性冠状动脉造影检查评估冠脉粥样硬化的程度。主要观察指标为病变支数和冠脉狭窄指数(以美国心脏病学会((AHA)的标准进行评分)。结果：2型糖尿病伴尿微量白蛋白组较不伴尿微量白蛋白组胰岛素抵抗指数明显增加，有统计学意义（P<0.05）。2型糖尿病伴尿微量白蛋白组较不伴尿微量白蛋白组冠状动脉硬化病变的支数增多，冠脉狭窄指数升高，以及弥漫性病变发生比率增高(P<0.05)。2型糖尿病伴尿微量蛋白组组内随着病变指数的增多尿微量蛋白/肌酐和胰岛素抵抗指数明显升高。双支病变组和多支病变组比单支病变组尿微量蛋白/肌酐比值明显升高(P<0.01)，多支病变组较双支病变组也有升高(P<0.01)；双支病变组和多支病变组比单支病变组胰岛素抵抗更明显(P<0.01)，多支病变组与双支病变组比较也有统计学意义(P<0.01)。结论：2型糖尿病患者尿微量白蛋白与胰岛素抵抗与冠脉粥样硬化程度密切相关。尿微量白蛋白与胰岛素抵抗联合检测可预测2型糖尿病冠脉粥样硬化的程度。