胰岛素抵抗在动脉粥样硬化性脑梗死与腔隙性脑梗死中的作用

目的探讨胰岛素抵抗在动脉粥样硬化性脑梗死和腔隙性脑梗死发病中的作用。方法对48例动脉粥样硬化性脑梗死、38例腔隙性脑梗死患者和40例健康对照者进行了研究。采用葡萄糖氧化酶法测定空腹血糖及糖负荷后2h血糖浓度;采用放射免疫法测定空腹血胰岛素及糖负荷后2h血胰岛素浓度;采用发色底物法测定血浆组织型纤溶酶原激活物和纤溶酶原激活物抑制剂1活性;采用氧化酶法测定甘油三酯的浓度;酶法测定总胆固醇和高密度脂蛋白胆固醇浓度;低密度脂蛋白胆固醇浓度由公式求出;采用免疫法测定载脂蛋白A和B的浓度;免疫比浊法测定脂蛋白(a)的浓度;采用常规方法测定收缩压、舒张压和体质指数;采用空腹血糖与胰岛素浓度乘积的倒数的自然对数作为胰岛素敏感性指数。结果动脉粥样硬化性脑梗死和腔隙性脑梗死患者的空腹血糖(6.58±3.16mmolL和6.34±2.30mmolL)、空腹血胰岛素(13.6±9.1mIUL和13.4±8.1mIUL)、糖负荷后2h血糖浓度(9.2±2.3mmolL和9.2±2.5mmolL)、糖负荷后2h血胰岛素浓度(99.0±54.3mIUL和98.4±53.9mIUL,)、收缩压(150.2±18.2mmHg和152.4±13.6mmHg)、舒张压(96.2±12.7mmHg和97.4±18.6mmHg)、甘油三酯(1.71±0.68mmolL和1.68±0.99mmolL)、低密度脂蛋白胆固醇(3.06±0.29mmolL和3.01±0.40mmolL)、总胆固醇(5.11±0.35mmolL和4.98±0.34mmolL)、脂蛋白(a)(238±202mgL和234±217mgL)、纤溶酶原激活物抑制剂1(880±350AUL和870±150AUL)和体质指数(26.5±1.1kgm2和26.3±2.0kgm2)显著高于对照组(P<0.01);动脉粥样硬化性脑梗死和腔隙性脑梗死患者的胰岛素敏感性指数(-4.20±0.24和4.19±1.02)、高密度脂蛋白(1.24±0.48mmolL和1.23±0.18mmolL)和组织型纤溶酶原激活物(280±160IUL和250±180IUL)显著低于对照组(P<0.01),两组患者间各参数比较差异无显著性(P>0.05)。两组患者的胰岛素敏感性指数与收缩压、舒张压、甘油三酯、载脂蛋白B、纤溶酶原激活物抑制剂1和体质指数呈负相关,与高密度脂蛋白胆固醇和载脂蛋白A呈正相关,与总胆固醇、低密度脂蛋白胆固醇、脂蛋白(a)和组织型纤溶酶原激活物不相关。结论胰岛素抵抗作为动脉粥样硬化性脑梗死和腔隙性脑梗死的重要危险因素,在脑的大、中动脉粥样硬化和小动脉硬化中发挥了重要作用。

Role of Insulin Resistance in Atherosclerotic Cerebral Infarction and Lacunar Cerebral Infarction

Aim To explore the role of insulin resistance (IR)in atherosclerotic cerebral infarction (ACI)and lacunar cerebral infarction (LCI). Methods The serum concentrations of insulin after overnight fast and glucose load were determined by the use of radioimmunoassay and the serum concentrations of glucose, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), lipoprotein (a) [Lp(a)], apolipoprotein A and B (ApoA, ApoB) after overnight fast and the serum concentrations of glucose after glucose load were measured by biochemical methods in 48 patients with ACI and 38 patients with LCI and 40 healthy control subjects. The plasmatic activities of tissue-type plasminogen activator (tPA)and plasminogen activator inhibitor-1 (PAI-1) were assayed by chromgenic substrate methods and levels of blood pressure and body mass index (BMI) was tested by routine ways in all subjects. Insulin sensitivity index (ISI) was estimated by the negative natural logarithm of the verse of fasting serum glucose and insulin product. Results The serum concentrations of glucose and insulin after overnight fast and glucose load (6.6±3.2 mmol/L and 6.3±2.3 mmol/L, 9.2±2.3 mmol/L and 9.2±2.5 mmol/L, 13.6±9.1 mIU/L and 13.4±8.0 mIU/L, 99.0±54.3 mIU/L and 98.4±53.9 mIU/L) were significantly higher in the two groups of cerebral infarction compared with the healthy control subjects (p<0.01), while the ISI (-4.20±0.24 and -4.19±1.02) in the two groups of cerebral infarction was significantly lower compared with the healthy control subjects (p<0.01). The increased levels of SBP(150.2±18.2 mmHg and 152.4±13.6 mmHg), DBP(96.2±12.7 mmHg and 97.4±18.6 mmHg), TG(1.71±0.68 mmol/L and 1.68±0.99 mmol/L), LDL(3.06±0.29 mmol/L and 3.01±0.40 mmol/L), TC(5.11±0.35 mmol/L and 4.98±0.34 mmol/L), Lp(a) (238±202 mg/L and 234±217 mg/L), PAI-1(880±350 AU/L and 870±150 AU/L) and BMI (26.5±1.1 kg/m2 and 26.3±2.0 kg/m2)were significantly observed in the two groups of cerebral infarction compared with the healthy control subjects (p<0.01), whereas decreased levels of HDL (1.24±0.48 mmol/L, 1.23±0.18 mmol/L)and tPA (0.28±0.16 kIU/L, 0.25±0.18 kIU/L) were detected significantly in the two groups of cerebral infarction compared with the healthy control subjects (p<0.01). The difference of all above parameters between two patients` groups had no statistical significance(p<0.05). In the patients with ACI and the patients with LCI, the ISI was negatively associated with the increased level of SBP, DBP, TG, ApoB, PAI-1 and BMI, but the ISI was positively associated with the decreased levels of HDL and ApoA, whereas the ISI was not associated with the levels of TC, LDL, Lp (a) and tPA. Conclusions IR which is the important risk factor in ACI and LCI plays an important part in both the atherosclerosis of large and medium cerebral arteries and the arteriosclerosis of small cerebral arteries.