基于胰岛素抵抗痰瘀型代谢综合征及冠心病干预随访研究

Metabolic syndrome(MS) is the most important risk factor of coronary heart disease(CHD), which can lead to or accelerate artherosclerosis, and increase the plaques' instability; while artherosclerosis is the pathological basis of CHD, plaque rupture can induce ACS, which is very dangerous to patient. Insulin resistance (IR) is common physiological and pathological basis of MS and CHD, improving IR is the effective treatment measure. Phlegm and blood stasis are key factors in the formation of IR, which exist all along in the process of MS and CHD. The project chooses patients with MS, CHD,MS+CHD, phlegm and blood stasis syndrome, takes IR as the key point, uses Chinese compound preparation to intervene MS and CHD from activating phlegm and blood stasis and treating them simultaneously; the patients will be follow-up visited to estimate their end-point events. From one aspect, the result will reveal that early intervening IR can prevent MS developing to CHD, decrease patients' cardiovascular risk with MS+CHD, so preventing and decreasing the end-point events to improve the prognosis. From another aspect, the results can validate the material fundament of phlegm and blood stasis syndrome, elevate identifying ability of phlegm and blood stasis syndrome in CHD, so provide new thought for the study of syndrome essence, offer theory support for activating hypothesis of phlegm and blood stasis, supply theory basis for preventing and treating CHD with Chinese drugs from the angle of improving IR.

代谢综合征（MS）是冠心病极其重要的危险因素，可引起或者加速动脉粥样硬化的进程，并增加斑块的不稳定性，而冠心病的病变基础则是动脉粥样硬化，粥样斑块破裂可导致急性冠脉综合征的发生，危及患者的生命。IR是MS和冠心病的共同生理病理基础，改善IR是治疗上述疾病的有效措施；痰瘀是IR形成过程中的关键因素，贯穿于MS和冠心病的始终。本课题以单纯MS、冠心病、MS合并冠心病的痰瘀型患者为研究对象，围绕IR，从痰瘀活化、痰瘀同治角度选用中药复方制剂，进行多方位、多靶点的干预及临床终点事件随访研究。一方面揭示中医早期干预ＩＲ，可防止MS向冠心病的演变，降低MS合并冠心病患者的心血管风险，防止或减少临床终点事件的发生，改善预后。另一方面验证痰瘀证候产生的物质基础，提高对冠心病"痰瘀"证的辨识能力，为证候实质研究提供新的思路和借鉴，为痰瘀活化假说提供理论支持，也为中药从改善IR角度防治冠心病提供理论依据。

研究背景：代谢综合征（MS）是冠心病极其重要的危险因素，可引起或者加速动脉粥样硬化(AS)的进程，并增加斑块的不稳定性，而冠心病的病变基础则是AS，粥样斑块破裂可导致急性冠脉综合征的发生，危及患者的生命。IR是MS和冠心病的共同生理病理基础，改善IR是治疗上述疾病的有效措施；痰瘀是IR形成过程中的关键因素，贯穿于MS和冠心病的始终。.研究内容：以单纯MS、冠心病合并MS的痰瘀型患者为研究对象，用酶联免疫吸附法测定血清脂联素、MCP-1、P选择素、CD40L，围绕MS、CHD和IR的关系进行研究。.研究结果：1. 脂联素在健康对照组、MS组和CHD合并MS组间差异有统计学意义（P<0.05）；MCP-1在健康对照组、MS组和CHD合并MS组间差异有统计学意义（P<0.01）；HOMA-IR在健康对照组、MS组和CHD合并MS组间差异有统计学意义（P<0.05）。2. Pearson相关性：脂联素与高血压呈负相关；MCP-1与腰围呈正相关，与高血压呈正相关；HOMA-IR与MCP-1、糖尿病、高血压、HS-CRP均呈正相关。3. 多元逐步线性回归分析：以脂联素、MCP-1、HOMA-IR分别为因变量，显示性别、高血压、HDL-c与脂联素具有相关性；腰围、HDL-c与MCP-1具有相关性；空腹血糖与HOMA-IR具有相关性。.研究结论：MS、CHD合并MS痰瘀型患者脂联素水平降低、MCP-1水平增加,与胰岛素敏感指数有关，CHD合并MS组脂联素水平与冠脉狭窄程度明显相关；提示MS和CHD均存在IR，脂联素、MCP-1所引起的IR加重了AS的进展，在MS发展为CHD中起到了一定作用，而脂联素和MCP-1的水平可反映IR和冠心病病情的严重程度，有一定的疾病诊断、预测价值。