多梗死性痴呆患者血浆、脑脊液胰岛素含量与智能水平的关系

Relationship of insulin levels in plasma and cerebrospinal fluid with the intellectual level of patients with multi-infarct dementia

目的 研究多梗死性痴呆 (MID)患者血浆、脑脊液 (CSF)胰岛素水平的变化及其与智能水平的关系。 方法 采用放射免疫测定法 (RIAs)对 5 5例MID患者血浆、CSF胰岛素含量进行测定 ,并与 72例脑梗死 (CI)患者及 3 2例健康对照进行比较。患者智能水平测定采用简易智能量表(MMSE) ,并参考DSM Ⅳ诊断标准及Hachinski缺血评分。 结果 MID急性发作组〔(8 92± 1 69)mIU/L〕和稳定期组〔(8 14± 2 0 1)mIU/L〕患者血浆胰岛素水平高于对照组〔(6 5 9± 1 46)mIU/L〕(P均 <0 0 1) ,而CSF胰岛素含量、CSF/血浆胰岛素比值显著低于对照组 (P <0 0 1) ,且CSF/血浆胰岛素比值与患者MMSE评分呈正性相关关系 (r=0 75 42 ,P <0 0 1)。CI急性期组血浆胰岛素水平显著高于对照组 (P <0 0 5 ) ,但CSF/血浆胰岛素比值与MID急性期组和MID稳定期组比较均有显著性差异 (P <0 0 1)。 结论 MID患者异常的血浆、CSF胰岛素水平可能是参与其智能损害的多种病理生理机制之一。

Objective To study the insulin levels in plasma and cerebrospinal fluid (CSF) and their relationship with intellectual level of patients with multi infarct dementia(MID). Methods The concentration of insulin in plasma and CSF in 55 patients with MID was determined by radioimmunoassay. Seventy two patients with cerebral infarction (CI) and 32 normal subjects used as controls were compared. Mini mental state examination (MMSE) was used to examine the intellectual level of patients and DSM IV diagnosis standard and Hachinski Ischemia Score were used as references. Results The patients in MID acute episode group and MID stationary phase group showed significantly higher plasma insulin level than that in normal controls( P <0 01), but had lower CSF insulin level and reduced CSF to plasma insulin ratio than that in normal controls( P <0 01) There was a positive correlation between CSF to plasma insulin ratio and MMSE score( r =0 7542, P <0 01). The patients in CI acute phase group had a higher plasma insulin levels than that in normal controls ( P <0 05), but their CSF to plasma insulin ratio differed statistically from either MID acute episode group or MID stationary phase group ( P <0 01). Conclusions The change in plasma and CSF insulin levels might be one of the pathophysiological mechanisms that results in the decline in intellectual level in MID patients.