胰岛素抵抗、血脂异常与急性脑梗死关系的初步研究
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摘要
1．背景与目的
目前，大量研究显示胰岛素抵抗(IR)及代偿性高胰岛素血症(HIS)与高血压、非胰岛素依赖性糖尿病(NIDDM)、冠心病(CAD)和血脂代谢障碍密切相关。现已证明胰岛素抵抗是缺血性心脏病的独立危险因素，在近几年中其和缺血性脑血管疾病(CAD)的关系日益受到关注。本研究旨在探讨胰岛素抵抗、血脂异常和急性脑梗死之间的关系。
2．方法
对45例急性脑梗死患者作空腹血糖(FPG)、血清胰岛素(FINS)及血脂测定，并与25例原发性高血压(EH)患者及25例健康体检者比较。采用李光伟提出的方法计算胰岛素敏感性指数(ISI)：为空腹血清胰岛素与空腹血糖乘积的倒数，即1／(FINS×FPG)，取其自然对数。
3．结果
急性脑梗死患者FINS明显高于两对照组(P＜0.01)；胰岛素敏感性指数(ISI)明显低于两对照组(P＜0.01)；TG、CHOL、apoB明显高于健康对照组(P＜0.01)，HDL明显低于健康对照组(P＜0.01)。FPG、LDL及apoAl三组间无明显差异。
4．结论
急性脑梗死存在胰岛素抵抗，胰岛素抵抗和血脂异常可能在脑梗死的发生中起重要作用。胰岛素抵抗在脑梗死中的重要作用有待于进一步深入研究。
1.Backgroud and Objective:
At present, numerous studies have shown that there is a closed correlation between insulin resietance (IR), compensatory hyperinsulinemia(HIS) and hypertension, obseity, non-insulin dependent diabetes(NIDDM), coronary artery diease(CAD), lipid metabolic abnormality. IR have been proved as an independent risk factor in patients with ischemic heart diease,and its role in cerebral vascular diease(CVD) have beening increasingly concerned during the past several years.This study aimed to investigate the relationship between IR,blood lipid abnormality and acute cerebral infarction. 2.Methods
Fasting plasma glucose(FPG), fasting seruminsulin(FINS), hemoglobin-Ale (GHbAlc) and the blood lipid were measured in three groups:(l)Group A:45 patients with acute cerebral infarction;(2)Group B:25 patients with essential hypertension as control;(3)Group C:25 healthy volunteers as normal control.The method which Li Guangwei proposed to caculate the insulin sensitivity index(ISI) was adopted. 3.Results
The study showed that FINS were significantly higher whereas ISI was significantly lower in acute cerebral infarction group than those in the two controls(P<0.01);TG,CHOL and apoB were significantly higher whereas HDL was significantly lower in acute cerebral infarction group than in the healthy controls(P<0.01).And there were no significant difference in FPG,LDL and apoAl in the three groups.
4.Conclusion
IR is existed in acute cerebral infarction,IR and lipid abnormality were probably played an important role in the pathologic process of cerebral infarction.The significance of IR in cerebral infarction needs to be further investigated.
目前，大量研究显示胰岛素抵抗(IR)及代偿性高胰岛素血症(HIS)与高血压、非胰岛素依赖性糖尿病(NIDDM)、冠心病(CAD)和血脂代谢障碍密切相关。现已证明胰岛素抵抗是缺血性心脏病的独立危险因素，在近几年中其和缺血性脑血管疾病(CAD)的关系日益受到关注。本研究旨在探讨胰岛素抵抗、血脂异常和急性脑梗死之间的关系。
2．方法
对45例急性脑梗死患者作空腹血糖(FPG)、血清胰岛素(FINS)及血脂测定，并与25例原发性高血压(EH)患者及25例健康体检者比较。采用李光伟提出的方法计算胰岛素敏感性指数(ISI)：为空腹血清胰岛素与空腹血糖乘积的倒数，即1／(FINS×FPG)，取其自然对数。
3．结果
急性脑梗死患者FINS明显高于两对照组(P＜0.01)；胰岛素敏感性指数(ISI)明显低于两对照组(P＜0.01)；TG、CHOL、apoB明显高于健康对照组(P＜0.01)，HDL明显低于健康对照组(P＜0.01)。FPG、LDL及apoAl三组间无明显差异。
4．结论
急性脑梗死存在胰岛素抵抗，胰岛素抵抗和血脂异常可能在脑梗死的发生中起重要作用。胰岛素抵抗在脑梗死中的重要作用有待于进一步深入研究。
1.Backgroud and Objective:
At present, numerous studies have shown that there is a closed correlation between insulin resietance (IR), compensatory hyperinsulinemia(HIS) and hypertension, obseity, non-insulin dependent diabetes(NIDDM), coronary artery diease(CAD), lipid metabolic abnormality. IR have been proved as an independent risk factor in patients with ischemic heart diease,and its role in cerebral vascular diease(CVD) have beening increasingly concerned during the past several years.This study aimed to investigate the relationship between IR,blood lipid abnormality and acute cerebral infarction. 2.Methods
Fasting plasma glucose(FPG), fasting seruminsulin(FINS), hemoglobin-Ale (GHbAlc) and the blood lipid were measured in three groups:(l)Group A:45 patients with acute cerebral infarction;(2)Group B:25 patients with essential hypertension as control;(3)Group C:25 healthy volunteers as normal control.The method which Li Guangwei proposed to caculate the insulin sensitivity index(ISI) was adopted. 3.Results
The study showed that FINS were significantly higher whereas ISI was significantly lower in acute cerebral infarction group than those in the two controls(P<0.01);TG,CHOL and apoB were significantly higher whereas HDL was significantly lower in acute cerebral infarction group than in the healthy controls(P<0.01).And there were no significant difference in FPG,LDL and apoAl in the three groups.
4.Conclusion
IR is existed in acute cerebral infarction,IR and lipid abnormality were probably played an important role in the pathologic process of cerebral infarction.The significance of IR in cerebral infarction needs to be further investigated.
引文
1. Haffner SM, Valdez RA, Hazuda HP, et al. Prospective analysis of the insulin resistance syndrome(Syndrome X) [J]. Diabetes,1992; 41(6): 715-722
2. Despres JP, Lamarche B, Mauriege P, et al. Hyperinsulinenia is an independent risk factor in ischemic heart diease [J]. N Eng J Med, 1996; 334:952-958
3. Shinozaki K, Hiroaki N, Takao S, et al. Role of insulin resistance associated with compensatory hyperinsulinemia in ischemicstroke [J].1996; 27:37-43
4．柳太云．胰岛素抵抗、高脂血症与缺血性脑卒中[J]．临床神经病学杂志，1999；12(1)：32-33
5．李光伟，潘孝仁，Stephen LI，等．检测人群胰岛素敏感性的一项新指标[J]．中华内科杂志，1993；32(10)：656-660
6. Pett K, Jacob S, Wickimary M. Possible synergistic effect of ACE inhibition and calcium channel blocked on insulin sensitivity in insulin resistance type Ⅱdiabetic hypertensive patients[J]. Cardiovase Pharmacol, 1994; 23(Suppl-1): 29-33
7．吴江，张淑琴，吴琼，等．脑血栓患者血脂脂蛋白apoAl、apoB变化的观察[J]．神经病杂志，1993；32：656-658
8. Kinura N. Atherosclerosis in Japan epidemiology [J]. Atherosclerosis Review, 1977; 2:209-212
9. Reed D, Yano K, Kagan A. Lipid and liporoteins as predictors of coronary heart disease, stroke and cancer in the Honolulu heart program[J]. Am J Med, 1986; 80:871-873
10． Matsuda M, Myahara T, Murai A, et al. Lipoproteins abnormality in survivors of cerebral infarction with a special reference to apolipoproteins and triglyceride rich Iipoproteins[J]. Atherosclero-sis, 1987; 68: 131-134
11． Bonora ? Willeit J, Kiexhl S, et al. Relationship between insulin and carotid atherosclerosis in the general population the bruneck study[J]. Stoke, 1997; 28: 1147-1152
12． Pollare T. Insulin resistance is a characteristic feature of primary hypertension independent of obesity [J]. Metabolism, 1990, 39(2) : 167-174
2. Despres JP, Lamarche B, Mauriege P, et al. Hyperinsulinenia is an independent risk factor in ischemic heart diease [J]. N Eng J Med, 1996; 334:952-958
3. Shinozaki K, Hiroaki N, Takao S, et al. Role of insulin resistance associated with compensatory hyperinsulinemia in ischemicstroke [J].1996; 27:37-43
4．柳太云．胰岛素抵抗、高脂血症与缺血性脑卒中[J]．临床神经病学杂志，1999；12(1)：32-33
5．李光伟，潘孝仁，Stephen LI，等．检测人群胰岛素敏感性的一项新指标[J]．中华内科杂志，1993；32(10)：656-660
6. Pett K, Jacob S, Wickimary M. Possible synergistic effect of ACE inhibition and calcium channel blocked on insulin sensitivity in insulin resistance type Ⅱdiabetic hypertensive patients[J]. Cardiovase Pharmacol, 1994; 23(Suppl-1): 29-33
7．吴江，张淑琴，吴琼，等．脑血栓患者血脂脂蛋白apoAl、apoB变化的观察[J]．神经病杂志，1993；32：656-658
8. Kinura N. Atherosclerosis in Japan epidemiology [J]. Atherosclerosis Review, 1977; 2:209-212
9. Reed D, Yano K, Kagan A. Lipid and liporoteins as predictors of coronary heart disease, stroke and cancer in the Honolulu heart program[J]. Am J Med, 1986; 80:871-873
10． Matsuda M, Myahara T, Murai A, et al. Lipoproteins abnormality in survivors of cerebral infarction with a special reference to apolipoproteins and triglyceride rich Iipoproteins[J]. Atherosclero-sis, 1987; 68: 131-134
11． Bonora ? Willeit J, Kiexhl S, et al. Relationship between insulin and carotid atherosclerosis in the general population the bruneck study[J]. Stoke, 1997; 28: 1147-1152
12． Pollare T. Insulin resistance is a characteristic feature of primary hypertension independent of obesity [J]. Metabolism, 1990, 39(2) : 167-174