不同类型急性脑梗死患者危险因素和胰岛素抵抗的临床研究

Clinical analysis of risk factors and insulin resistance in patients with different subtypes of acute cerebral infarction

目的探讨经典的脑梗死危险因素和胰岛素抵抗(IR)在不同类型急性脑梗死(ACI)中的作用。方法ACI患者110例,对照组45例。根据TOAST分型法将ACI患者分为大动脉粥样硬化性脑梗死(LAA)和小动脉闭塞/腔隙性脑梗死(SAO)两组。测定两组患者血压、体质指数(BMI)、腹围、空腹血糖(FBG)、空腹胰岛素(FINS)、血脂、血尿酸(UA)等指标。采用稳态评估法(HOMA)得出的胰岛素抵抗指数(HOMA-IR)作为判断IR的指标。结果SAO组与对照组比较,收缩压明显升高[(138.1±20.9)mm Hg vs(129.7±15.4)mm Hg,P<0.05];LAA组与对照组比较,BMI[(26.1±3.4)kg/m2 vs(24.6±4.1)kg/m2,P<0.05]、腹围[(95.0±10.4)cm vs(90.1±10.5)cm,P<0.05]、收缩压[(141.1±19.7)mm Hg vs(129.7±15.4)mm Hg,P<0.01]、低密度脂蛋白(LDL)[(3.23±0.90)mmol/L vs(2.87±0.71)mmol/L,P<0.05]及UA[(335±110)mmol/Lvs(295±90)mmol/L,P<0.05]明显升高,高密度脂蛋白(HDL)明显降低[(1.08±0.29)mmol/Lvs(1.26±0.33)mmol/L,P<0.01];与SAO组及对照组比较,LAA组中FBG[(5.82±2.98)mmol/Lvs(4.76±0.84)mmol/L,(4.75±0.79)mmol/L,P<0.01]及HOMA-IR[(0.38±0.27)vs(0.28±0.23),(0.24±0.27),P<0.05]明显升高。LAA组简单相关分析显示HOMA-IR与收缩压、舒张压、BMI、腹围、UA、TG呈正相关,与HDL呈负相关。多元回归分析显示,UA与HOMA-IR独立相关。结论高血压可能是引起SAO病变的主要原因,而高血压、血脂异常、高UA、超重或肥胖与LAA的发病有关,且LAA存在IR,并通过影响多种危险因素而参与LAA的发生。

Objective To explore the effect of classic risk factors and insulin resistance in different subtypes of acute cerebral infaction （ACI）. Methods 110 ACI patients and 45 controls were investigated. Based on TOAST criteria, all ACI patients were divided into two main subtypes： large artery atherosclerosis stroke（LAA） and small-artery occlusion （SAO）. Blood pressure, body mass index（BMI）, abdominal circumference, blood lipids, uric acid（UA）, fasting blood glucose （FBG）and fasting insulin（FINS） were measured. Insulin resistance was determined by HOMA-IR. Results Compared with the control group, systolic pressure in SAO was higher [ （138.1 ±20.9）mmHg vs （129.7±15.4）mmHg, P〈0.05 ] while in LAA group, BMI [ （26.1 ±3.4）kg/m^2 vs （24.6±4.1）kg/m^2, P〈0.05], abdominal circumference [ （95.0±10.4）cm vs （90.1±10.5）cm, P〈0.05], systolic pressure [（141.1±19.7）mmHg vs （129.7±15.4）mmHg,P〈0.01], LDL [（3.23±0.90） mmol/L vs （2.87±0.71）mmol/L, P〈0.05], UA[ （335_＋1 10）mmol/L vs （295±90）mmol/L,P〈0.05 ]were higher compared with the control group; and the HDL was lower[ （1.08±0.29）mmol/L vs （1.26±0.33）mmol/L,P〈0.01 ]. In SAO group than control group, FBG[ （5.82±2.98）mmol/L vs （4.76±0.84）mmol/L,（4.75±0.79）mmol/L,P〈0.01 ]and HOMA-IR [ （0.38±0.27） vs （0.28 ±0.23 ）, （0.24±0.27）, P〈0.05]in LAA were higher than control group. Single factor correlation analysis in LAA group showed that the HOMA-IR was positively correlated with systolic pressure, diastolic pressure, BMI, abdominal circumference, UA, TG but was negatively correlated with HDL. Using HOMA-IR as a dependent variable in a stepwise regression analysis, only UA was independently correlated with HOMA-IR. Conclusions Hypertension may be the main reason of SAA, while hypertension, disturbance of blood lipids, hyperuricemia, overweight or obesity are associated with occurrence of LAA. In addition, IR is found in LAA. It is possibly involved in the occurrence of LAA by affecting the risk factors of cerebral infarction.