老年2型糖尿病合并无症状性脑梗死患者血清尿酸与血脂及胰岛素敏感指数的改变

Study on the changes of Serum uric acid,lipids and insulin sensitive index in elderly type-2 diabetic patients with asymptomatic cerebral infarction

目的探讨2型糖尿病(T2DM)并发无症状性脑梗死(SCI)与血清尿酸(SUA)、血脂、胰岛素(Ins)水平的关系。方法122例T2DM患者,分为T2DM合并SCI组、单纯SCI组和单纯糖尿病(DM)组,分别进行SUA、血胆固醇(TC)、血甘油三酯(TG)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、极低密度脂蛋白胆固醇(VLDLC)、载脂蛋白A(ApoA)、载脂蛋白B(ApoB)及脂蛋白LP(a)测定,对DM患者均做馒头餐试验和Ins水平测定并计算胰岛素敏感性指数(IAI)。结果T2DM合并SCI组的血TC、TG、LDLC、VLDLC及ApoB水平均比单纯SCI组高;T2DM合并SCI组的SUA水平比单纯SCI组和单纯DM组增高(P<0.05);T2DM合并SCI组与单纯DM组相比较,血Lp(a)及Ins水平升高(P<0.05),而HDLC、ApoA降低(P<0.01),同时IAI降低。结论DM合并高尿酸血症、低HDL血症等脂代谢异常及胰岛素抵抗在DM合并SCI的发病中可能起重要作用。

Objective To investigate the levels of serum uric acid,lipids and insulin in elderly type-2 diabetic patients with asymptomatic cerebral infarction.Methods The levels of serum uric acid,total cholesterol(TC),triglyceride(TG),high density lipoprolein caolesterol(HDL-C),VLDL-C,ApoA,ApoB,and lipoprolein(a) were measured in 122 randomly selected patients whom were divided in three groups:type-2 diabetic patients with asymptomatic cerebral infarction,simple cerebral infarction patients and simple type-2 diabetic patients.oral glucose tolerance test and plasma insulin were determined in all type-2 diabetic patients.Results The levels of serum TC,TG,LDL-C,VLDL-C,and ApoA,ApoB,in type-2 diabetic patients were higher than those in patients with cerebral infarction.the levels of serum uric acid in type-2 diabetic patients with cerebral infarction was significantly higher than that in patients with cerebral infarction and patients with type-2 diabetic mellitus(P<0.05).The levels of lipoprotein(a) and serum insulin in type-2 diabetic patients with cerebral infarction were higher than those in patients with type-2 diabetes mellitus(P<0.05).The levels of serum HDL,ApoA and IAI in type-2 diabetic patients with asymptomatic cerebral infarction were significantly lower than those in patients with type-2 diabetes mellitus(P<0.01).Conclusion Hyperuricemia,lipid metabolic disorder and insulin resistance in elderly type 2 diabetic patients play an important role in the pathogenesis of cerebral infarction of patients with diabetes mellitus.