摘要
目的:观察瘦素、胰岛素敏感指数在脑梗死患者急性期血清水平变化,探讨其与患者梗死体积及神经功能缺损的关系。方法:选择华北煤炭医学院附属医院2004-02/2005-02收治的86例急性脑梗死患者为观察对象。测定其急性期血清中的瘦素、胰岛素、血糖、胰岛素敏感指数的水平,与同期健康体检者31例对照。将脑梗死患者按梗死体积分为小梗死组(<5cm3),中梗死组(5～15cm3),大梗死组(>15cm3);根据神经功能缺损程度评分分为轻度损伤组(0～15分),中度损伤组(16～30分),重度损伤组(31～45分),比较不同梗死体积和损伤程度时瘦素水平、胰岛素抵抗程度的变化,并进行血清瘦素与胰岛素抵抗之间的直线相关和回归分析。结果:按实际处理分析,117例观察对象全部进入结果分析。①脑梗死组的血糖、瘦素水平显著高于对照组[(7.05±2.22),(5.39±0.88)mmol/L;(17.85±15.09),(9.21±4.76)μg/L,(P<0.05)],胰岛素、胰岛素敏感指数显著低于对照组[(11.22±3.35),(19.75±8.06)mIU/L;-0.94±0.52,-1.89±0.79,(P<0.05)]。②脑梗死体积越大,脑梗死患者血清中瘦素、胰岛素、血糖越高(F=15.79～12.00,P<0.05),胰岛素敏感指数越低(F=24.27,P<0.05)。③神经功能缺损程度越重,脑梗死患者血清中瘦素、胰岛素、血糖越高(F=14.28～11.00,P<0.05),胰岛素敏感指数越低(F=23.24,P<0.05)。④直线与相关回归分析表明瘦素与胰岛素、血糖呈显著正相关(r=0.53,0.26,P<0.001),与胰岛素敏感指数呈显著负相关(r=-0.66,P<0.001)。结论:①脑梗死体积越大,神经功能缺损评分越高,瘦素水平越高,胰岛素抵抗程度越重,提示瘦素抵抗、胰岛素抵抗可加重缺血性脑损害。②瘦素水平越高,胰岛素抵抗程度越重,脑梗死体积越大,神经功能缺损评分越高,提示观测脑梗死患者血清瘦素水平及胰岛素抵抗程度对脑组织损伤程度及预后判断有一定的价值。③瘦素抵抗与胰岛素抵抗可能相互促进、相互影响促进脑梗死的发生,加重病情。
AIM：To observe the changes of serum leptin and insulin sensitivity index （ISI）in patients with acute cerebral infarction, and to probe into the relationship of serum leptin and ISI with infarction volume and neurologic impairment.
METHODS：Eighty-six patients with, acute cerebral infarction and thirtyone synchronously examined healthy people （controls） were collected from the Affiliated Hospital of North China Coal Medical College between February 2004 and February 2005. The levels of leptin, blood insulin, fasting blood sugar and ISI were detected in all the subjects. The patients with cerebral infarction were divided into small infarction group （〈 5 cm^3）, middle infarction group （5 to 15 cm^3） and large infarction group （〉 15 cm^3） according to the infraction volume. Based on the scoring of neurologic impairment degree from standards of CSS in 1995：mild impairment （0 to 15 points）, moderate impairment （16 to 30 points） and severe impairment （31 to 45 points）. Changes of leptin level and insulin resistance were compared in patients with different cerebral infarction volume and different impairment degree.l,inear correlation and regression analysis were performed to leptin and insulin resistance. RESULTS：According to actual management,all the 117 subjects were involved in the result analysis. （1） The levels of blood sugar and serum leptin were significantly higher in the cerebral infarction group than those in the control group [（7.05±2.22）, （5.39±0.88） mmol/L; （17.85±15.09）, （9.21±4.76）μg/L,P 〈 0.05],but the levels of insulin , IS1 of the cerebral infarction group were significantly higher than those in the control group [（ 11.22±3.35）, （ 19.75±8.06） mIU/L; -0.94±0.52. -1.89±0.79,P 〈 0.05]. （2）The larger the infarction volume was in the patients with cerebral infarction, the higher the levels of serum leptin, insulin and blood sugar were （F=15.79 to 12.00,P 〈 0.05）and the lower the level of ISI was （F=24.27,P〈0.05）. （3）The severer the neurologic impairment degree was in the patients with cerebral infarction, the higher the levels of serum leptin, insulin and hlood sugar were（F=14.28 to 11.00,P〈0.05）and the lower the level of ISI was （F=23.24,P〈0.05）. （4）Linear correlation and regression analysis results showed that the level of leptin was significantly positively correlated with the levels of insulin and blood sugar （r=0.53, 0.26,P 〈 0.001）,and the level of leptin was significantly negatively correlated with the level of ISI（r=-0.66 ,P〈0.001）. CONCLUSION： （1） The larger the infarction volume is,the higher the neurologic impairment scores are, and the higher the level of leptin is, and the severer the degree of the insulin resistance is, indicating that the leptin resistance, e and .insulin resistance aggravates the cerebral ischemia. （2）The higher the level of leptin is,or the severer the degree of the insulin resistance is,the larger the infraction volume is,and the higher the neurologic impairment scores are, indicating that the level of leptin and the degree of the insulin resistance play an important role in the evaluation of cerebral tissue injury degree and prognosis. （3）The leptin resistance and insulin resistance may have an indirect action in the occurrence and aggraviation of cerebral infarction, and influence on each other.
出处
《中国临床康复》
CSCD
北大核心
2005年第45期79-81,共3页
Chinese Journal of Clinical Rehabilitation
