脑梗死合并高血压与糖尿病时胰岛素抵抗的临床观察

目的　观察老年人脑梗死合并高血压、糖尿病时胰岛素抵抗 (IR)的情况。方法　 4 1例单纯脑梗死患者 (组 1) ,2 1例脑梗死合并高血压患者 (组 2 )、19例脑梗死合并糖尿病患者 (组 3)及 2 6例正常对照组 ,分别测定收缩压 (SBP)、舒张压 (DBP)、空腹血糖 (FBG)、空腹胰岛素 (FINS)、C肽、总胆固醇 (TC)、甘油三酯 (TG)、低密度脂蛋白胆固醇 (LDL C)、高密度脂蛋白胆固醇 (HDL C)、载脂蛋白 (Apo)A1及ApoB。 结果　 3组患者的SBP、DBP、FBG、FINS、TG、ApoB均明显高于对照组 ,胰岛素敏感性指数则明显下降(P <0 .0 5或P <0 .0 1)。组 1、组 2的C肽显著高于对照组 ,组 2、组 3的TC及LDL C显著高于对照组 ,而HDL C、ApoA1仅在组 3与对照组比较差异明显 (P <0 .0 5 )。组 2与组 1比较 ,SBP、DBP、FINS及C肽有所升高 ,但仅SBP、DBP有统计学意义。组 3与组 1比较 ,TG、TC、LDL C差异显著。结论　老年脑梗死患者存在明显的IR ;合并高血压或糖尿病时 ,IR、代谢紊乱更为严重。

Clinical observation of insulin resistance in patients suffering from cerebral infarction with hypertension and diabetes mellitus

Objective To observe insulin resistance(IR) in patients suffering from cerebral infarction with hypertension and diabetes mellitus.Methods Systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),fasting insulin(FINS),C-peptide,total cholesterol(TC),triglyceride(TG),LDL-C,HDL-C,Apoprotein(Apo)A_1 and Apo B were measured in 41 patients with cerebral infarction(group 1),21 patients with cerebral infarction and hypertension(group 2),19 patients with cerebral infarction and diabetes mellitus(group 3) and 26 healthy controls.Results SBP,DBP,FBG,FINS,TG and Apo B in all three groups were significantly higher ,but insulin sensitivity index was significantly lower than that of the controls respectively(P<0.05 or P<0.01 ). C-peptide in group 1 and group 2,TC and LDL-C in group 2 and group 3,had significant difference from the controls ,while HDL-C and Apo A_1 were lower than the controls only in group 3.Compared with group 1,SBP and DBP in group 2,TG,TC and LDL-C in group 3,were much higher(P<0.05).Conclusion Insulin resistance is significantly associated with cerebral infarction.Furthermore,hypertension and diabetes mellitus could exacerbate insulin resistance and lipid abnormality in patients with ischemic cerebral vascular disease.