| BackgroundCoronary atherosclerotic heart disease,the most common and popular heart disease all over the world,has been one of the leading causes of death from the developing countries to the developed countries.At present,the incidence of coronary heart disease among Chinese residents remains high,and the incidence of acute myocardial infarction is also rapidly increasing.Therefore,rapid and accurate diagnosis,early intervention,effective monitoring and improvement of the prognosis and quality of life of patients with acute myocardial infarction have become an urgent problem to be solved.Studies have shown that insulin is essential for the maintenance of normal cardiovascular activities.Once the cardiovascular system cannot receive insulin signals normally,it will lead to cardiovascular disease.When the cardiovascular system cannot receive insulin signals normally and insulin resistance occurs,the risk of cardiovascular diseases such as CHD increases.As we all know,diabetes mellitus(DM)is one of the important risk factors for CHD.There is obvious insulin resistance in diabetic patients.When acute myocardial infarction occurs in diabetic patient,aggregated inflammatory cells in the ischemic necrotic myocardial tissue trigger an inflammatory response,which aggravates myocardial injury and thrombosis through cardiomyocyte apoptosis and necrosis,and dysfunction of vascular endothelial cells.However;there is also insulin resistance in non-diabetic patients with acute myocardial infarction,which is manifested by a significant decrease in glucose uptake and a significant decrease in the responsiveness of myocardial contraction to insulin.In view of the current research,the relationship between serum insulin,inflammatory factors TNF-α,IL-6,CRP levels and the complexity of coronary artery disease is not yet clear in non-diabetic patients with acute myocardial infarction.Exploring the relationship between insulin,inflammation levels and the complexity of coronary artery disease in these patients will provide a theoretical basis for how to control insulin levels in vivo to improve the prognosis of patients with acute myocardial infarction.Objetive1.To analyze the differences in serological indicators such as inflammatory factors,cardiac function and the degree of coronary artery stenosis between groups with different insulin levels,non-diabetic patients with acute myocardial infarction were enrolled and divided into groups according to serum insulin levels in the clinical study;2.To explore whether the insulin levels and inflammatory factors TNF-α,IL-6,CRP level can be used as an index to predict the degree of coronary artery stenosis in patients with non-diabetic acute myocardial infarction,which could provide a new idea for guiding clinicians to rationally evaluate and treat acute myocardial infarction,especially acute myocardial infarction in non-diabetic patients,through analyzing the relationship between insulin levels,inflammatory factors TNF-α,IL-6,CRP levels and the degree of coronary artery stenosis in patients with non-diabetic acute myocardial infarction.MethodsAccording to inclusion and exclusion criteria,patients who were performed Coronary Angiogram(CAG)in Qilu hospital were admitted to our study from February 2019 to December 2019.The general information was collected,including the sex,age and the relevant laboratorial results such as fasting blood-glucose,serum lipids,myocardial enzymes and their isoenzymes,troponin.We acquired the information about the pathological blood vessels by the CAG.We recorded the left ventricular ejection fraction(LVEF)showed by the echocardiogram.We collected fasting venous blood for the first time after admission to detect serum insulin and inflammatory factors TNF-α,IL-6 and CRP through enzyme-linked immunosorbent assay(ELISA)in the biochemical laboratory.Since the normal reference range of fasting serum insulin is5-25 mU/L,the patients are divided into non-hyperinsulinemia group(NHINS,insulin<15 mU/L)and hyperinsulinemia group(HINS,insulin>15 mU/L).The differences in serological indicators,cardiac function and coronary artery stenosis between NHINS and HINS group were analyzed.In addition,the relationship between insulin,inflammatory factors TNF-α,IL-6,CRP levels and coronary stenosis in patients with non-diabetic AMI were explored.All data were statistically analyzed by software SPSS 16.0.Results:1.152 non-diabetic patients with acute myocardial infarction enrolled in the study,including 116 males(76.32%)and 36 females(23.68%).Among them,63 patients(41.45%)had serum insulin levell≤15mU/L,and 89 patients(58.55%)had serum insulin level>1 5mU/L.2.Serum inflammatory factors TNF-α(212.8±42.16 ng/L),IL-6(20.24±2.67 ng/L)and CRP(20.8±4.9 mg/L)levels in HINS group were significantly higher than the NHINS group(TNF-α 130.87±29.12 ng/L,IL-6 15.29±2.32 ng/L,CRP 14.83±3.87 mg/L)(P<0.05).3.LVEF(51.92±12.18%)in HINS was significantly lower than the NHINS group(56.25± 10.29%)(P<0.05).4.Gensini score(93.29±50.68)in HINS group weas significantly higher than the NHINS group(47.39±28.02)(P<0.05).5.The levels of insulin,TNF-,IL-6 and CRP in non-diabetic patients with acute myocardial infarction were positively correlated with the degree of coronary artery stenosis(P<0.01).6.The age,gender,LDL-C,BMI value and other traditional risk factors as well as insulin,TNF-,IL-6 and CRP of the enrolled patients were taken as independent variables,and Gensini score was taken as dependent variables into the equation for multiple linear regression analysis.Analysis showed that:the variance inflation factors(VIF)were less than 5,that is,there is no obvious correlation between the independent variable indicators.The corresponding P values of insulin,TNF-α,IL-6,and CRP were all less than 0.05,and the corresponding regression coefficients are all more than 0.Traditional risk factors such as age,gender,LDL-C,and BMI value of non-diabetic patients with acute myocardial infarction had no correlation with Gensini score,while insulin,TNF-α,IL-6.and CRP levels were positively correlated with Gensini score,which could be used to assess the degree of coronary stenosis in non-diabetic acute myocardial infarction patients.Conclusions1.Serum insulin and inflammatory levels increase,while cardiac function decreases in non-diabetic patients with acute myocardial infarctior.2.Serum insulin and inflammatory factors TNF-α,IL-6 and CRP levels were positively correlated with the degree of coronary artery stenosis in non-diabetic acute myocardial infarction patients.The above indicators can comprehensively predict and evaluate the severity of coronary artery stenosis in non-diabetic acute myocardial infarction patients to some extent. |
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