缺血性脑卒中患者游离脂肪酸水平及与胰岛素抵抗的相关性研究

The correlation between free fatty acid and insulin resistance in ischemic stroke patients

目的 探讨缺血性脑卒中（IS）患者血清中游离脂肪酸（FFA）水平以及与胰岛素抵抗（IR）的相关性.方法 采用病例对照研究方法,选取天津市第三中心医院2011年6月至2012年9月确诊的180例急性IS患者,按梗死灶大小分为大梗死灶组（57例）、中梗死灶组（63例）、小梗死灶组（60例）；同时选取60名健康体检者为对照组.检测血清FFA、空腹胰岛素（FINS）、空腹血糖（FBG）水平,利用稳态模式评估胰岛素抵抗指数（HOMA-IR）.同时测定甘油三酯（TG）、胆固醇（TC）、高密度脂蛋白胆固醇（HDL）、低密度脂蛋白胆固醇（LDL）、载脂蛋白A1 （APOA1）、载脂蛋白B（APOB）水平.采用Pearson直线相关对FFA水平与IR的相关性进行分析；采用多元逐步多因素回归分析进行FFA与HOMA-IR的关系分析.同时采用t检验及方差分析进行统计学分析.结果 IS患者血清FFA、FINS、FBG、FIB、TG、TC、LDL、APOB及HOMA-IR水平均明显高于健康对照组,差异均有统计学意义；而HDL、APOA1水平则明显低于健康对照组.IS患者血清FFA、FINS、HOMA-IR、FBG、TG、TC、HDL、LDL、APOA1、APOB水平与脑梗死面积有关,大梗死灶组FFA、FINS、HOMA-IR、FBG、TG、TC、LDL、APOB水平高于中、小梗死灶组；HDL、APOA1水平低于中、小梗死灶组,差异均有统计学意义.在IS组内,血清FFA水平与FINS、FBG、HOMA-IR呈正相关（r=0.870、0.497、0.792,P＜0.001）；与年龄不相关（r=0.008,P＞0.05）.在IS组内,以HOMA-IR为因变量,FFA、FINS、FBG、TG、TC、HDL、APOA1、APOB为自变量的多元逐步回归分析显示,除FINS、FBG、TC、LDL、APOB外,FFA也是HOMA-IR的独立危险因素.结论 IS患者FFA升高,FFA水平与IR存在相关性,FFA是IS患者IR的独立危险因素.

Objective To explore the level of free fatty acid（FFA） in ischemic stroke（IS） patients and its correlation with insulin resistance （IR）. Methods This study was case-control study. Patients who were diagnosed with IS were followed up from June, 2011 to September, 2012 in Tianjin Third Central Hospital. The 180 IS patients were divided into large infarct （57）, middle infarct（ 63 ）and small infarct（ 60 ） according to the area of infarct. At the same time , 60 healthy persons were selected as control group. The plasma FFA, fasting insulin （ FINS ）, fasting blood glucose （ FBG ）, homeostasis model assessment （HOMA） -IR, triacylglycerol（ TG）, total cholesterol （ TC ）, high density lipoprotein cholesterol-C （ HDL）, low density lipoprotein cholesterol-C（ LDL）, lipoprotein A1 （ APOA1 ） and lipoprotein B （ APOB ） in 180 IS patients were measured and compared with that of control group. The correlation between FFA and IR was analyzed by using pearson linear correlation. The relationship between FFA and HOMA-IR was analyzed by using multiple stepwise multivariate analysis. The t test and analysis of variance were used for statistical analysis. Results Compared to normal control, the level of FFA, FINS, FBG, FIB, TG, TC, LDL, APOB and HOMA-IR in IS patients were higher, the difference was statistically. The level of HDL, APOA1 in IS patients were lower than that of normal control. The level of FFA, FINS, HOMA-IR, FBG, TG, TC, HDL, LDL, APOA1 and APOB in IS patients related to the area of infarct. The level of FFA, FINS, HOMA-IR, FBG, TG, TC, LDL, APOB in large infarct were higher than those in middle infarct and small infarct. The level of HDL, APOA1 in large infarct were lower than those in middle infarct and small infarct, the difference were statistically. In IS patients, FFA had positive correlation to FINS, FBG and HOMA-IR （r = 0. 870,0. 497,0. 792,P 〈 0. 001 ） , but had no correlation to age （ r = 0. 008, P 〉 0. 05 ）. In IS patients, HOMA-IR was dependent variable, but FFA, FINS, FBG, TG, TC, HDL, APOA1 and APOB were independent variable. FFA was independent risk factor to HOMA-IR, besides FINS, FBG, TC, LDL and APOB. Conclusion FFA elevates in IS patients,FFA has correlation to IR and it is a dependent risk factor to IS patients.