新型糖尿病肠内营养制剂改善急性重症缺血性脑卒中病人的血糖和胰岛素抵抗状态

A new type diabetes-specific formula attenuates insulin resistance and blood glucose level in acute ischemic stroke patients

目的:研究急性重症缺血性脑卒中病人的胰岛素抵抗状态,并探讨可能改善病人血糖和胰岛素抵抗状态的肠内营养(EN)制剂。方法:采用随机对照前瞻性研究,对脑卒中量表评分(NIHSS)≥10分并伴有吞咽困难的急性缺血性脑卒中病人62例,随机分为新型糖尿病EN治疗组(A组)和传统糖尿病EN治疗组(B组)。观察两组病人的胰岛素抵抗状态,并比较使用不同EN制剂病人治疗第7天的营养状况和胰岛素抵抗水平。结果:1治疗第7天,两组急性重症脑卒中病人的营养状况均无明显变化,其中A组病人的血脂明显改善;2治疗第7天,A组EN支持12 h后血糖和日血糖最大波动幅度均显著低于B组(P<0.05)。A组治疗后胰岛素抵抗指数(HOMA-IR)、空腹血糖、营养支持后8和12 h血糖、日血糖最大波动幅度均较治疗前有显著改善(P<0.05)。结论:新型糖尿病型EN制剂不仅对急性缺血性脑卒中病人提供足够的能量支持,而且能改善病人胰岛素抵抗状态,协助控制血糖。

Objective： To investigate the percentage of insulin resistance among severe acute ischemic stroke and to investigate whether a new type of diabetes-specific formula would attenuates the insulin resistance and blood glucose level after acute isehemic stroke. Methods： 62 acute ischemic patients with NIHSS score more than 10 and swallow problems were enrolled. All patients were randomized to new type diabetes-specific formula group （ group A） or tradition diabetes-specific formula group （ group B）. Outcomes of interest were measures of nutrition and insulin resistance at baseline and 7 days after admission. Results： HOMA-1R, fasting blood-glucose, 8 and 12 h postprandial glucose level and blood glucose fluctuation level were improved in group A. Conclusion ： A new type diabetes-specific formula can provide an adequate nutrition and ameliorate the insulin resistance in acute ischemic stroke patients.