老年脑梗死合并糖尿病时胰岛素抵抗的临床观察

Clinical Observation of Insulin Resistance in Senior Patients with Cerebral Infarction with Diabetes Mellitus

目的探讨老年脑梗死并糖尿病(DM)时胰岛素抵抗(insulin resistance,IR)的发生情况。方法选择58例恢复期脑梗死患者,根据有无DM分为单纯脑梗死组35例和脑梗死并DM组23例;同时选择同期体检健康者26例作为正常对照组,分别测定体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、空腹胰岛素(FINS)、C肽、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白(Apo)A1及ApoB,并计算胰岛素敏感指数(ISI)及敏感性。结果 3组BMI、C肽比较差异无统计学意义(P>0.05)。单纯脑梗死组、脑梗死并DM组FBG、SBP、DBP、TC、TG、ApoB明显高于正常对照组,ISI低于正常对照组(P<0.05,P<0.01),脑梗死并DM组FBG、DBP、TC、TG、LDL-C高于单纯脑梗死组(P<0.05)。脑梗死并DM组与正常对照组LDL-C、HDL-C及ApoA1、FINS比较差异有统计学意义(P<0.05,P<0.01)。以正常对照组胰岛素相对敏感性为100%,单纯脑梗死组和脑梗死并DM组的胰岛素相对敏感性分别为71%和50%。结论正常老年脑梗死患者存在明显的IR,合并DM时IR及代谢紊乱更为严重,应早期干预。

Objective To investigate insulin resistance（IR） in patients suffering from cerebral infarction with diabetes mellitus（DM）.Methods 58 patients with cerebral infarction were divided into simple cerebral infarction group（n=35） and cerebral infarction with DM group（n=23）,and 26 healthy controls were regarded as normal control group.Systolic blood pressure（SBP）,diastolic blood pressure（DBP）,fasting blood glucose（FBG）,fasting insulin（FINS）,C-peptide,total cholesterol（TC）,triglyceride（TG）,LDL-C,HDL-C,Apo protein（Apo）A1,ApoB,insulin sensitivity index（ISI） and sensitivity were measured.Results There was no significant difference of BMI and C-peptide between the groups（P〉0.05）,FBG,SBP,DBP,TC,TG and ApoB in simple cerebral infarction group and cerebral infarction with DM group were higher than that in the normal control group,and ISI was lower than that in the normal control group,and the differences were significant（P〈0.05,P〈0.01）,and FBG,DBP,TC and TG were higher in cerebral infarction with DM group when compared with that in simple cerebral infarction group（P〈0.05）.There were significant differences of LDL-C,HDL-C,ApoA1 and FINS between cerebral infarction with DM group and normal control group（P〈0.05）.The relative sensitivity of insulin in the control group was 100%,but in simple cerebral infarction group and cerebral infarction with DM group they were 71% and 50% respectively.Conclusion IR exists in senior patients with cerebral infarction.It becomes serious when IR is associated with DM,and further intervention is necessary.