目的·探索无糖尿病病史患者胰岛素抵抗水平与ST段抬高型心肌梗死（ST-segment elevation myocardial infarction，STEMI）后左室重构的相关性。方法·连续入组自2014年1月—2022年12月收治于上海交通大学医学院附属瑞金医院心内科因STEMI行急诊经皮冠状动脉介入治疗的无糖尿病病史患者，随访6个月。收集患者的年龄、性别、吸烟情况、体格检查（血压、体质量指数等）、生化指标（肝肾功能、血脂、血糖、心肌肌钙蛋白峰值等）、用药情况等资料。采用稳态模型评估胰岛素抵抗指数（homeostasis model assessment of insulin resistance，HOMA-IR）作为反映胰岛素抵抗水平的指标。根据随访期间测定的平均HOMA-IR的四分位数，将患者分为4组：低水平组、中低水平组、中高水平组、高水平组。分别于基线和随访结束时行超声心动图检查，分析胰岛素抵抗水平与STEMI后左室重构的相关性。结果·共纳入219例患者，平均年龄（62.7±11.9）岁，男性占85.4%（187例）。平均随访时间为（6.4±1.8）个月。随访期间平均测定HOMA-IR（4.32±2.18）次，HOMA-IR中位数为2.41（1.58，3.98），高于正常人群水平。随着HOMA-IR水平的升高，心肌梗死后的左室舒张末内径（P=0.027）及左室舒张末容积指数（P=0.013）从整体上呈扩张趋势。Pearson相关性分析显示，随访期间的平均HOMA-IR水平（log变换后）与左室舒张末容积指数变化值（r=0.20，P=0.003）和左室舒张末内径变化值（r=0.21，P=0.002）呈正相关。多元回归分析进一步表明，在校正了年龄、性别、传统危险因素（高血压病史、体质量指数、吸烟史、肾功能、血脂等）、药物治疗情况及基线左室射血分数和心肌肌钙蛋白峰值后，高水平HOMA-IR仍然是STEMI后左室重构的独立危险因素。与低水平HOMA-IR组相比，高水平组患者的左室舒张末容积指数增加7.727 mL/m²（P<0.001）。结论·无糖尿病病史的STEMI患者普遍存在胰岛素抵抗，且胰岛素抵抗水平是心肌梗死后左室不良重构的独立预测因子。

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 (Δ LV end-diastolic volume index: r=0.20, P=0.003; Δ 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.