老年急性脑梗死患者治疗前后胰岛素抵抗变化对照组分析  

Changes of insulin resistance before and after treatment in elderly patients with acute cerebral infarction:a controlled analysis

作　　者：耿纪录[1] 徐浩民[1] 郭青云[1] 盛春燕[1] 李晓利[1] 陈昕[1] 白秉学[1] 

机构地区：[1]解放军总医院第三○九临床部第二干部病房,北京市100091

出　　处：《中国临床康复》2005年第17期90-92,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:以胰岛素相对敏感性为胰岛素抵抗的代表指标,分析老年急性脑梗死患者治疗前后,并与急性期非相应治疗及恢复期脑卒中患者和健康对照组比较胰岛素抵抗的变化及其意义。方法:选择2000-07/2003-04解放军总医院第三○九临床部第二干部病房收治老年脑梗死患者49例,年龄>60岁,无糖尿病和胰岛素应用史,按病程、头颅CT或MRI将其分为两组:①急性脑梗死组33例,病程<3周,影像学显示有新鲜的病灶。其中25例进行了治疗,包括低分子肝素钠1432IU,皮下注射,2次/d,共1周;葛根素注射液0.5g及胞二磷胆碱注射液0.75g,静滴,1次/d,共2周。②恢复期脑梗死组16例,病程≥3周。对照组26例为同期老年健康查体者。所有被试者均测定了空腹血糖、空腹血清胰岛素及C肽、胰岛素敏感性指数和胰岛素相对敏感性。以胰岛素相对敏感性为主要观察指标,同时进行其他相关因子的比较分析。结果:3组75例受试者全部进入结果分析。①以对照组胰岛素相对敏感性为100%,急性脑梗死组和恢复期脑梗死组分别为42%和67%。②25例经治疗的急性脑梗死组患者,以治疗前胰岛素相对敏感性为100%,治疗后为150.7%。结论:①老年急性脑梗死患者对胰岛素的相对敏感性下降,即存在着胰岛素抵抗现象,恢复期患者仍存在胰岛素抵抗现象,但程度明显减轻。AIM:To analyze the changes of insulin resistance with relative insulin sensitivity as the marker before and after treatment in elderly patients with acute cerebral infarction in comparison with those after non relevant treatment in acute period,stroke patients during restoration period and healthy controls.METHODS:A total of 49 elderly cerebral infarction patients( > 60 years) without diabetes mellitus and the use of insulin were selected from the Second Cadre's Ward of the 309 Clinical Division of General Hospital of Chinese PLA from July 2000 to April 2003.They were divided randomly into two groups according to the course of diseases,CT and MRI.① Acute cerebral infarction group(n=33):the course of disease was < 3 weeks,and fresh focus was indicated in imaging.Among them,25 received subcutaneous injection of 1 432 IU heparin sodium,twice per day for 1 week,and intravenous injection of 0.5 g kakonein and 0.75 g corenalin,once per day for 2 weeks.② Acute cerebral infarction during restoration period group(n=16):the course of disease was ≥ 3 weeks.A total of 26 healthy elderly persons were selected as controls.Fasting blood glucose,fasting insulin,C peptide, insulin sensibitity index and relative insulin sensibitity were detected.The relative insulin sensibitity was considered as the main observational marker.Meanwhile,the relative analysis about other factors was performed.RESULTS:All 75 subjects in the three groups were involved in the result analysis.① The relative insulin sensibitity was 100% in control group,42% in acute cerebral infarction group and 67% in acute cerebral infarction group during restoration period . ② The relative insulin sensibitity was 100% in acute cerebral infarction group before treatment,and 50.7% after treatment.CONCLUSION:① The relative insulin sensibitity decreases in elderly acute cerebral infarction patients,which indicates insulin resistance exists.Alleviatived insulin resistance also exists in acute cerebral infarction patients during restoration period.② Insulin sen

关 键 词：脑梗塞 胰岛素抗药性 血糖 胰岛素 胆固醇 甘油三酯类 

分 类 号：R743[医药卫生—神经病学与精神病学]