脑卒中患者血糖水平变化及其原因

探讨脑卒中患者血糖变化的原因。采用葡萄糖氧化酶-过氧化酶法和放射免疫分析法分别对90例脑卒中患者的血糖水平和血清促肾上腺皮质激素(ACTH)、胰高血糖素(GCG)、胰岛素(INS)、生长激素(GH)、皮质醇(COR)、甲状腺素(T4)及三碘甲状腺原氨酸(T3)浓度做动态检测；采用CT扫描确定病灶大小及脑组织病理改变情况(有无脑中线移位、脑室受压和血肿破入脑室等)；对血糖水平与激素浓度和脑组织病理改变之间的关系做相关研究。结果表明：90例脑卒中患者中有38例发生高血糖，发生率为42．22％；血糖水平与GCG和COR浓度成正相关，与T3成负相关；发病10天后高血糖组的血糖水平和相关激素浓度均恢复正常。高血糖组ACTH浓度和脑组织病理改变的发生率均显著高于正常血糖组和对照组，而ACTH升高组脑组织病理改变的发生率显著高于ACTH正常组。结论：脑卒中血糖升高的原因可能与下丘脑受刺激后引起ACTH和GCG释放因子分泌增加，继而与血清COR和GCG水平升高、T3水平降低有关。

Change of Blood Glucose Level and Its Possible Mechanism in Patients with Cerebral Stroke

To study the mechanism of the change of blood glucose levels in patients with cerebral stroke, the levels of blood glucose, cortisol, glucogen, insulin, growth hormone, triidothyronine(T 3), thyroxine(T 4) and adrenocorticotropic hormone(ACTH) were dynamically measured in 90 patients with cerebral stroke. The circumstances of brain middle line movement, lateral ventricle oppression and entrance brain ventricle of burst hematoma of the patients were examines by CT scan.The total incidence of hyperglycemia in the patients was 42.22%.The blood glucose level was positively related to the cortisol and glucogen levels, and negatively related to the T 3 level. The changed level of blood glucose and its related hormones both returned to normal range in 10 days. Both the ACTH level and the rate of cerebral pathological change in hyperglycemia group were significantly higher than that in normoglycemia and control groups. The rate of cerebral pathological change in elevated ACTH level group was higher than that in normal ACTH level group. The mechanism of hyperglycimia in the patients with cerebral stroke might be related to the stimulation of the hypothalamus, which may induce the discharge of ACTH and glucagon releasing factor, and to that the level of cortisol and glucagon increased, the level of T 3 decreased.