合并脑血管病变对老年2型糖尿病患者胰岛素抵抗的影响

Influence of cerebrovascular disease on insulin resistance in elderly patients with type 2 diabetes mellitus

目的分析合并脑血管病变对老年2型糖尿病(T2DM)患者胰岛素抵抗的影响。方法选取2015年4月~2017年3月我院收治的老年T2DM患者110例为研究对象,其中合并脑血管病变(脑梗死)者纳入观察组(n=60),不合并脑梗死患者纳入对照组(n=50),比较两组空腹血糖(FBG)、糖化血红蛋白(HbA1c)、胰岛素相关指标[空腹胰岛素(FIns)、胰岛素敏感指数(ISI)、胰岛素抵抗指数(HOMA-IR)]、神经功能缺损程度评分(NIHSS)及脑动脉TCD参数[VS2/VS1、PI],同时依据ISI情况将观察组分为轻型组(ISI>-4.52)、重型组(ISI≤-4.52),比较其FBG、HbA1c、FIns、NIHSS评分及TCD相关参数,并分析观察组患者ISI、HOMA-IR与NIHSS评分及TCD参数相关性。结果观察组FBG、HbA1c、ISI、HOMA-IR、NIHSS评分、颅内受检动脉VS2/VS1、PI高于对照组(P<0.05),而组间FIns比较差异无统计学意义(P>0.05);观察组中重型组FBG、HbA1c、NIHSS评分、颅内受检动脉VS2/VS1、PI高于轻型组(P<0.05),而FIns比较差异无统计学意义(P>0.05);相关性分析显示T2DM合并脑血管病变患者FBG、HOMA-IR、NIHSS评分、VS2/VS1、PI与其ISI呈正相关(P<0.05)。结论老年T2DM合并脑血管病变患者胰岛素抵抗现象较单纯T2DM患者严重,患者神经功能受损程度更大,应予以重视。

Objective To analyze the effect of cerebrovascular disease on insulin resistance in elderly patients withtype 2 diabetes mellitus（T2DM）. Methods 110 elderly patients with T2DM who were admitted to our hospital fromApril 2015 to March 2017 were selected as our study objects. Patients with cerebrovascular disease（cerebral infarction）were included in the observation group（n=60）. Patients without cerebral infarction were included in the control group（n=50）. The fasting plasma glucose （FBG）, hemoglobin A1c（HbA1c）, insulin-related indicators[FIns, insulin sensitivityindex（ISI）, insulin resistance index（HOMA-IR）], neural function deficit level score（NIHSS）and cerebral arterial TCDparameters [VS2/VS1, PI] were compared between the two groups. The patients in the observation group were divided intolight group （ISI〉-4.52）and heavy group （ISI臆-4.52） based on the ISI conditions , and FBG, HbA1c, FIns, NIHSSscores and TCD-related parameters were compared between the two groups. The correlations among ISI, HOMA-IR,NIHSS scores and TCD parameters in the observation group were analyzed as well. Results The FBG, HbA1c, ISI,HOMA-IR, NIHSS scores, intracranial artery VS2/VS1, PI in the observation group were higher than those in the controlgroup（P〈0.05）, but there was no significant difference in FIns between the groups（P〉0.05）. In the observation group,FBG, HbA1c, NIHSS scores intracranial artery VS2/VS1, and PI in the heavy group were higher than in the light group（P〈0.05）, while there was no significant difference in FIns between the groups（P〉0.05）; There was a positive correlation between FBG, HOMA-IR, NIHSS scores, VS2/VS1, PI and ISI in T2DM patients with cerebrovascular disease （P〈0.05）. Conclusion The insulin resistance in elderly T2DM patients with cerebrovascular disease was more serious thanthat of patients with T2DM alone. The patients suffered greater neurological impairment elderly patients with T2DM,which should be stressed.