Ⅱ型糖尿病并发脑梗塞与高胰岛素血症的关系探讨

A study on the relationship between type Ⅱ diabetes with cerebral infarction and hyperinsulinemia

检测21例正常人（Ⅰ组）、32例非糖尿病伴脑梗塞患者（Ⅱ组）、38例Ⅱ型糖尿病无脑梗塞患者（Ⅲ组）和38例Ⅱ型糖尿病伴脑梗塞患者（Ⅳ组）血清葡萄糖、胰岛素、C肽水平，并计算胰岛素敏感性指数（血糖／胰岛素，ISI）、胰岛素／C肽比值及胰岛素、C肽释放试验曲线下面积。结果：Ⅳ组患者血清空腹胰岛素水平、胰岛素／C肽比值及胰岛素曲线下面积高于Ⅰ、Ⅱ、Ⅲ组患者，空腹C肽值和C肽曲线下面积高于Ⅰ组患者，而ISI低于Ⅰ组和Ⅲ组患者。结论：Ⅱ型糖尿病并发脑梗塞患者存在明显的胰岛素抵抗（IR）和高胰岛素血症（HIS），胰岛β细胞分泌胰岛素过多和血清胰岛素降解减少可能参与了这类患者HIS的形成，此与非糖尿病脑梗塞患者不同，HIS可能与Ⅱ型糖尿病患者脑梗塞的高发病率有关。

To investigate the relationship between hyperinsulinemia(HIS) and diabetic cerebral infarction (CBI), serum glucose, insulin (IS ), C-peptide (CP), insulin-sensitivity index (glucose/IS, ISI ), IS/CP ratio,and the areas under the curves (AUC) of IS and CP release tests were determined in 21 normal controls (group Ⅰ),32 non-diabetic cases with CB Ⅰ (group Ⅱ),38 type Ⅱ diabetics without CBI (group Ⅲ ) and 38 type Ⅱ diabetics with CB Ⅰ (group Ⅳ). Results:The levels of fasting serum IS,IS/CP ratio and AUC of IS were increased in group Ⅳ as compared with groups Ⅱ, Ⅱ and Ⅲ. The values of fasting CP and AUC of CP in group Ⅳ were higher than those in group Ⅰ,but ISI was lower than those in groups Ⅰ, Ⅱ. COnclusion: There are obvious insulin resistance(IR) and HIS in the type Ⅱ diabetics with CBI. Insulin hypersecretion and the reduction of insulin clearance might participate in the formation of HIS in the diabetics with CBI,which is different from the non-diabetics with CBI. HIS might be related to the high incidence of CBI in type Ⅱ diabetes.