上海交通大学学报（医学版）2025，Vol.45Issue(3)：292-300,9.DOI:10.3969/j.issn.1674-8115.2025.03.005
无糖尿病病史患者胰岛素抵抗水平与急性ST段抬高型心肌梗死后左室重构的相关性
Association between insulin resistance and left ventricular remodeling after STEMI in patients without a history of diabetes mellitus
摘要
Abstract
Objective·To investigate the association of insulin resistance with left ventricular(LV)remodeling after ST-segment elevation myocardial infarction(STEMI)in patients without a history of diabetes mellitus.Methods·This study consecutively enrolled STEMI patients without a history of diabetes mellitus who underwent percutaneous coronary intervention in the Department of Cardiology of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,from January 2014 to December 2022.The patients were followed up for 6 months.Age,gender,smoking status,blood pressure,body mass index,biochemical indexes(liver function,kidney function,lipid profiles,glycemic levels and peak troponin levels,etc.)and pharmacological treatment were recorded.Homeostasis model assessment of insulin resistance(HOMA-IR)was used to evaluate insulin resistance and mean values of visit-to-visit HOMA-IR were calculated.Patients were divided into 4 groups(low-level group,low-to-medium-level group,medium-to-high-level group,and high-level group)according to the quartiles of mean HOMA-IR levels.Echocardiography was performed at baseline and during follow-up.Then the association between mean values of insulin resistance and post-infarction LV remodeling was analyzed.Results·A total of 219 patients were finally included,with an average age of(62.7±11.9)years,and male patients accounted for 85.4％(187 cases).The average follow-up time was(6.4±1.8)months.During follow-up,the average number of HOMA-IR measurements was(4.32±2.18),and the mean value of visit-to-visit HOMA-IR was 2.41(1.58,3.98),which was higher than normal range.The results showed that post-infarction LV end-diastolic diameter(P=0.027)and LV end-diastolic volume index(P=0.013)generally showed a trend for dilation with increasing mean HOMA-IR levels.Pearson correlation analysis revealed the mean values of visit-to-visit HOMA-IR were positively correlated to changes in LV dimensions(△ LV end-diastolic volume index:r=0.20,P=0.003;△ LV end-diastolic diameter:r=0.21,P=0.002).Multivariate regression analysis demonstrated that higher HOMA-IR was independently associated with greater LV dilation after STEMI,even after adjusting for age,gender,traditional risk factors(history of hypertension,body mass index,smoking status,renal function and lipid profiles),pharmacological treatment,baseline LV ejection fraction and peak troponin levels.Compared with patients with the lowest quartile of HOMA-IR,those with the highest HOMA-IR quartile exhibited a 7.727 mL/m2 increase in LV end-diastolic volume index(P＜0.001).Conclusion·This study reveals that insulin resistance is prevalent in STEMI patients without a history of diabetes mellitus.Insulin resistance is an independent predictor of adverse LV remodeling in this population.关键词
胰岛素抵抗/心肌梗死/左室扩张/重构Key words
insulin resistance/myocardial infarction/left ventricular dilation/remodeling分类
医药卫生引用本文复制引用
杨晨蝶,胡长青,袁贺,TAY Guan Poh,阿布力克木·阿木提,张瑞岩,王晓群..无糖尿病病史患者胰岛素抵抗水平与急性ST段抬高型心肌梗死后左室重构的相关性[J].上海交通大学学报（医学版）,2025,45(3):292-300,9.基金项目
国家重点研发计划(2022YFC2503502) （2022YFC2503502）
国家自然科学基金(82170423,82000369) （82170423,82000369）
上海交通大学医学院高峰学科-临床医学"研究型医师"(20240801) （20240801）
国家转化医学中心(上海)开放课题项目[NRCTM(SH)-2023-13] （上海）
上海交通大学医学院附属瑞金医院广慈-金光创新技术启航计划. National Key Research and Development Program of China(2022YFC2503502) （2022YFC2503502）
National Natural Science Foundation of China(82170423,82000369) （82170423,82000369）
Shanghai Jiao Tong University School of Medicine-Gaofeng Clinical Medicine Grant Support(20240801) （20240801）
Opening Project Program of the National Research Center for Translational Medicine at Shanghai[NRCTM(SH)-2023-13] （SH）
Guangci Innovative Technology Sailing Plan of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine. （）
