代谢综合征患者颈动脉粥样硬化与胰岛素抵抗及炎性因子的相关性研究

摘要

目的 探讨代谢综合征(MS)患者颈动脉粥样硬化与胰岛素抵抗(IR)及炎性因子的相关性.方法 选取2010年6月-2011年6月在我院及武警北京市总队第二医院就诊的MS患者68例,根据彩色多普勒超声检测颈动脉内膜中层厚度(IMT)将其分为内膜正常组22例、内膜增厚组24例、斑块形成组22例,同时选取26例健康体检者为对照组.测定4组血压、身高、体质量,计算体质指数(BMI),同时检测血脂、空腹血糖(FPG)、空腹胰岛素(FINS)、超敏C反应蛋白(hs-CRP)及肿瘤坏死因子α(TNF-α)水平,采用自我平衡模型分析法(HOMA)计算胰岛素抵抗指数(IRI).结果 4组受试者收缩压、舒张压、BMI、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、FPG、FINS、IRI、hs-CRP、TNF-α及IMT比较,差异均有统计学意义(P＜0.05).其中内膜正常组、内膜增厚组、斑块形成组与对照组收缩压、舒张压、BMI、TC、TG、LDL-C、HDL-C、FPG、FINS、IRI、hs-CRP、TNF-α及IMT比较,差异均有统计学意义(P＜0.05);斑块形成组与内膜正常组FPG、FINS、IRI、hs-CRP、TNF-α及IMT比较,差异均有统计学意义(P＜0.05);内膜增厚组与内膜正常组IRI、hs-CRP、TNF-α及IMT比较,差异均有统计学意义(P＜0.05);斑块形成组与内膜增厚组IRI、hs-CRP、TNF-α及IMT比较,差异均有统计学意义(P＜0.05).MS患者IMT与IRI、hs-CRP、TNF-α水平均呈正相关(r值分别为0.343、0.419和0.362,P＜0.05);IRI与hs-CRP及TNF-α水平均呈正相关(r值分别为0.547和0.538,P＜0.01);hs-CRP水平与TNF-α水平呈正相关(r=0.621,P＜0.01).结论 在MS患者中存在炎症反应和IR,炎性因子与IR在MS患者颈动脉粥样硬化的发生、发展过程中起着重要的作用.%Objective To explore the relationship between insulin resistance ( IR ), inflammation factors and carotid atherosclerosis in patients with metabolic syndrome ( MS ). Methods 68 MS patients from June 2010 to June 2011 were divided into normal IMT group ( 22 cases ), thickened IMT group ( 24 cases ) and atherosclerotic plaque group ( 22 cases ) according to carotid intima - media thickness ( IMT ) detected by color Doppler ultrasound. Meanwhile, 26 healthy people were selected as control group. Blood pressure, height, body weight, BMI, blood lipid, FPG, FINS, hs - CRP and TNF - α. were detected a-mong the four groups. Homeostasis model assessment ( HOMA ) was used to calculate insulin resistance index ( IRI ). Results Systolic blood pressure, diastolic blood pressure, BMI, TC, TG, LDL - C, HDL - C, FPG, FINS, IRI, hs - CRP, TNF - α and IMT between the four groups showed statistically significant differences ( P <0. 05 ). The systolic blood pressure, diastolic blood pressure, BMI, TC, TG, LDL-C, HDL-C, FPG, FINS, IRI, hs - CRP, TNF - α and IMT in normal IMT group, thickened IMT group and atherosclerotic plaque group showed statistically significant differences compared with those of the control group ( P <0. 05 ). The FPG, FINS, IRI, hs -CRP, TNF - α and IMT between atherosclerotic plaque group and normal IMT group showed statistically significant differences ( P <0. 05 ). The IRI, hs - CRP, TNF - α and IMT between thickened IMT group and normal IMT group showed statistically significant differences ( P <0. 05 ). The IRI, hs - CRP, TNF - α and IMT between atherosclerotic plaque group and thickened IMT group showed statistically significant differences ( P < 0. 05 ). The IMT was positively correlated with IRI, hs - CRP and TNF - α in MS patients ( r =0. 343 , 0. 419 and 0. 362, P <0. 05 ). IRI was positively correlated with hs - CRP and TNF - α ( r =0. 547 and 0. 538, P <0. 01 ). hs - CRP was positively correlated with TNF - α ( r =0. 621, P <0. 01 ). Conclusion There are inflammatory activity and IR in MS patients, and inflammatory activity and IR play an important role in the occurrence and development of carotid atherosclerosis in MS patients.