目的 本研究旨在探究胰岛素治疗老年冠心病合并2型糖尿病患者后抵抗代谢评分与心血管结局的相关性.方法 选取老年冠心病合并2型糖尿病住院患者作为研究对象,入组患者均给予胰岛素治疗,胰岛素起始剂量为3 U,于三餐前予以皮下注射用药,日用药总量控制0.3～0.8U·kg-1,记录患者主要不良心血管事件发生情况,分析胰岛素抵抗代谢评分(METS-IR)与其心血管结局的相关性以及对不良心血管事件发生的预测价值.结果 老年冠心病合并2型糖尿病患者接受胰岛素治疗前后,平均体质量指数(BMI)分别为(26.03±3.12)和(25.23±0.02)kg·m-2,三酰甘油(TG)分别为(123.60±21.46)和(113.70±19.75)mg·dL-1,血清总胆固醇(TC)分别为(155.80±14.19)和(153.40±13.98)mg·dL-1,低密度脂蛋白胆固醇(LDL-C)分别为(94.58±9.85)和(91.74±9.56)mg·dL=1,高密度脂蛋白胆固醇(HDL-C)分别为(46.02±4.47)和(49.73±4.83)mg·dL-1,空腹血糖(FBG)分别为(98.55±10.58)和(93.62±10.05)mg·dL-1,METS-IR 分别为39.26±4.80和36.89±4.50,除血浆TC外,上述指标治疗前后在统计学上差异均有统计学意义(均P＜0.05).入组患者发生不良心血管事件(MACE)共48例(22.2％),其中高血压23例,心绞痛14例,因心肌梗死住院治疗8例,因心力衰竭住院治疗3例.Spearman相关分析显示,METS-IR与不良心血管事件发生率呈显著正相关(P＜0.01).ROC曲线结果分析表明,METS-IR对老年冠心病合并2型糖尿病患者MACE发生的预测具有较高的预测价值.结论 老年冠心病合并2型糖尿病患者接受胰岛素治疗后METS-IR与其不良心血管事件发生率呈显著正相关,并对其心血管结局有较好的预测价值.
Objective This study aimed to investigate the correlation between insulin resistance score after insulin treatment in elderly patients with coronary heart disease and type 2 diabetes mellitus and cardiovascular outcomes.Methods Elderly patients with coronary heart disease complicated with type 2 diabetes mellitus were selected as the study subjects.All enrolled patients received insulin treatment with an initial dose of 3 U,administered subcutaneously before meals.The total daily dose of insulin was controlled at 0.3-0.8 U·kg-1.The occurrence of major adverse cardiovascular events(MACE)was recorded,and the correlation between insulin resistance score(METS-IR)and cardiovascular outcomes,as well as the predictive value for the occurrence of adverse cardiovascular events was analyzed.Results Before and after insulin treatment in elderly patients with coronary heart disease and type 2 diabetes mellitus,the average body mass index(BMI)were(26.03±3.12)and(25.23±0.02)kg·m-2,triglycerides(TG)were(123.60±21.46)and(113.70±19.75)mg·dL-1,total cholesterol(TC)were(155.80±14.19)and(153.40±13.98)mg·dL-1,low-density lipoprotein cholesterol(LDL-C)were(94.58±9.85)and(91.74±9.56)mg·dL-1,high-density lipoprotein cholesterol(HDL-C)were(46.02±4.47)and(49.73±4.83)mg·dL-1,and fasting blood glucose(FBG)were(98.55±10.58)and(93.62±10.05)mg·dL-1,respectively.The METS-IR scores were 39.26±4.80 and 36.89±4.50,respectively.Except for plasma TC,the differences in the above indicators before and after treatment were statistically significant(all P＜0.05).Among the enrolled patients,a total of 48 cases(22.2％)experienced MACE,including 23 cases of hypertension,14 cases of angina pectoris,8 cases of hospitalization for myocardial infarction,3 cases of hospitalization for heart failure.Spearman correlation analysis showed that METS-IR was significantly positively correlated with the incidence of adverse cardiovascular events(P＜0.01).ROC curve analysis indicated that METS-IR had a high predictive value for the occurrence of MACE in elderly patients with coronary heart disease and type 2 diabetes mellitus.Conclusion After insulin treatment in elderly patients with coronary heart disease and type 2 diabetes mellitus,METS-IR was significantly positively correlated with the incidence of adverse cardiovascular events and had good predictive value for cardiovascular outcomes.
丁亚桃;王中华;陈波
扬州大学医学院临床医学系,江苏扬州 225200||扬州洪泉医院心血管内科,江苏扬州 225200扬州洪泉医院心血管内科,江苏扬州 225200
药学
胰岛素;冠心病合并2型糖尿病;胰岛素抵抗代谢评分
insulin;coronary heart disease complicated by type 2 diabetes mellitus;metabolic score for insulin resistance
《中国临床药理学杂志》 2024 (001)
3-6 / 4
10.13699/j.cnki.1001-6821.2024.01.001
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