急性脑血管病高血糖相关激素的研究

Observation on changes of hormones associated with hyperglycemia in patients with acute cerebrovascular disease.

目的探讨急性脑血管病患者血糖及相关激素的变化。方法采用葡萄糖氧化酶法检测67例非糖尿病急性脑血管病患者的血糖水平,根据血糖值分为高血糖组(41例)和正常血糖组(26例),另设24例体检健康者为对照组。用放射免疫法和酶联免疫法检测促肾上腺皮质激素(ACTH)、胰高血糖素(GCG)、胰岛素(INS)含量,脑CT或MRI扫描确定病灶大小及脑组织结构改变(有无脑室受压、脑中线移位);对血糖水平、激素浓度和脑组织结构改变之间的关系做相关研究。结果高血糖组ACTH、GCG和INS显著增高;高血糖组和ACTH升高组脑组织结构改变的发生率显著高于正常血糖组和正常ACTH组。结论急性脑血管病血糖升高可能与下丘脑、垂体损伤有关,导致下丘脑—垂体—肾上腺皮质轴(HPA轴)分泌增强;脑血管病急性期血糖、ACTH、GCG升高,提示预后不良。

Objective To explore the variations of blood glucose level in patients with acute eerebrovascular disease （ACVD） and the active effects of relavant hormones. Methods Sixty - nine non - diabetic cerebrovascular disease patients were divided into hyperglycemia （HG） group consisted of 41 cases and normal blood glucose （NG） group consisted of 26 cases based on their blood glucose levels. Another 24 health subjects were taken as control. The levels of adrcnocorticotropic Hormone （ACTH）, glucogan （GCG）, insulin （INS） in serum were determined. The circumstance of brain middle llne movement, lateral ventricle oppression were examined by CT or MRI. The correlation of blood glucose, variations of hormone concentrations and cerebral structural change were analyzed. Results The levels of ACTH,GCG,INS in the sera of HG patients were significantly higher than that in sera of NG and controls （P 〈 0.01） .Both the ACTH level and rate of cerebral structural change in HG were siginificantly higher than that of NG. The incidence of cerebral structural change in elevated ACTH level group was higher than that in normal ACTH level group. Conclusion Hyperglycemia in patients with acute cercbrovascular disease may be associated with the enhancement of secretion of ACTH and GCG. The determination of the concentration of glucose, ACTH, GCG may be helpful for judging severity of illness, predicting the patient＇s prognosis and evaluating the effectiveness of treatment.