不同类型脑梗死与胰岛素抵抗的关系

Relationship between different types of cerebral infarction and insulin resistance.

目的探讨三种不同类型的脑梗死与胰岛素抵抗(IR)的关系。方法将50例已排除公认危险因素的脑梗死患者分为动脉粥样硬化性脑梗死(ATC I)组、腔隙性脑梗死(LC I)组及心源性脑梗死(CC I)组,分别检测空腹和葡萄糖耐量试验2 h后血糖及血清胰岛素浓度,计算胰岛素抵抗指数(IR I)。同时测定甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)的浓度,并分析血脂/载脂蛋白各指标与IR I的相关性。结果ATC I组和LC I组患者IR I与正常对照组比较差异均有显著性(均为P<0.01);同时ATC I和LC I患者血清TG、LDL-C及ApoB含量增加,而HDL-C、ApoA1含量显著降低(P<0.01或P<0.05),其中TG、LDL-C及ApoB与IR I呈显著正相关(r值分别为0.590、0.918、0.671,均为P<0.01),HDL-C、ApoA1与IR I呈显著负相关(r值分别为-0.582、-0.378,分别为P<0.01和P<0.05)。结论ATC I和LC I患者体内存在着IR,而CC I患者体内不存在IR;IR是ATC I和LC I的危险因素。

Objective To evaluate the relationship between three types of cerebral infarction and insulin resistance. Methods 50 patients with cerebral infarction, whose factors had been excluded from publicly accepted risk factors, were divided into atherothrombotic cerebral infarction group （ ATCI group ） ,lacunar cerebral infarction group （LCI group） and cardicembolic cerebral infarction group （CCI group）. Fasting blood glucose,serum glucose 2 h after oral glucose tolerance test （OGTT） and serum insulin concentration were measured and the insulin resistance index （IRI） was calculated. The concentrations of triglyceride （TG）, total cholesterol （TC）, high-density tipeprotein cholesterol （HDL-C） ,low density lipoprotein cholesterol （LDL-C）, apolipoprotein A1 （ApoAl） ,and apolipoprotein B （ ApeB ） were measured and the relationship between blood lipids and apolipoproteins IRI were analyzed. Results There were significant differences in IRI among ATCI group, LCI group and control group （P 〈 0.01 for each）. TG,LDL-C and ApeB contents were increased while HDL-C and ApoA, contents were decreased in ATCI and LCI group （P 〈 0.01 or P 〈 0. 05） ,of which TG, LDL-C and ApeB were positively correlated with IRI （ r = 0. 590, 0.918,0.671,P 〈 0.01 for each ）, while HDL-C and ApeA, were negatively correlated with IRI （ r = -0.582,-0.378 P 〈 0.01 and P 〈 0.05 ）. Conclusion IR presents in ATCI and LCI group but dose not exist in CCI group, so it is one the risk factors of ATCI and LCI.