脑梗塞患者胰岛素抵抗的研究

Study on the Phenomenon of Insulin Resistance(IR) in Patients with Cerebral Infaction

目的 :探讨脑梗塞急性期患者是否存在胰岛素抵抗 (IR) ;在急性期血糖升高 ,是否使用胰岛素治疗。方法 :本文测定了 5 0例脑梗塞患者和 30例健康人的空腹血糖 (FPG)、空腹血清胰岛素 (FINS)、血皮质醇(F) ,计算胰岛素敏感性指数 (ISI) ,并与神经功能缺损评分和病灶大小进行直线相关分析。结果 :脑梗塞急性期患者FPG、FINS及F显著高于对照组 (p <0 0 0 1) ,ISI较对照组明显降低 (p<0 0 0 1)。脑梗塞轻型组和中重型组的FPG、F、ISI之间也存在明显差异 (p <0 0 0 1、p <0 0 1、p<0 0 5 )。ISI与脑梗塞的面积呈负相关 (r =- 0 313,p<0 0 5 )。ISI与神经功能缺损评分也呈负相关 (r=- 0 317,p <0 0 5 )。中重型组的死亡率与病残率高于轻型组。结论 :脑梗塞患者急性期存在IR ,且急性期胰岛素水平及IR程度与患者病情与预后有关。

Objective To investigate the presence of the phenomenon of insulin resistance (IR) in patients with cerebral infarction and the indication for insulin therapy. Methods Fasting blood glucose (FPG), fasting serum insulin (FINS) and cortisol levels were measured in 50 patients with cerebral infaction and 80 controls. Insulin sensitivity index (ISI) was calculated from these data and linar correlation analysis was performed to the score of neurologic impairment as well as the size of lesion. Results FPG, FINS and cortisol levels in the patients were significantly higher than those of the control group ( p <0 001) with ISI significantly lower ( p <0 001) than those in the controls. Levels of there parameters were significanthy higher in patients with moderate-severe lesions than in patients with only mild lesion ( p <0 001, p<0 01,p<0 05 respectively). ISI was negatively correlated to the size of infarction ( r=-0 313,p <0 05) and also to the score of neurolgic impairement ( r=-0 317,p <0 05). The mortality and morbidity in the moderate-severe group were naturally higher than those in the mild group. Conclusion Insulin resistance does exist in the acute stage of cerebral infarction; severity of which and degree of hyperinsulinemia are related to the course and prognosis of the disease process. Insulin therapy should be considered in patients with hyperglycemia.