上海地区汉族人胰岛素抵抗与急性缺血性脑血管病关系的研究  

Study on the relationship between insulin resistance and acute ischemic cerebrovascular disease in yellow race

作　　者：余爱勇 胡筱媛 Yu Aiyong;Hu Xiaoyuan(Department of Neurology,Shanghai Songjiang District Central Hospital,Shanghai 201699,China)

机构地区：[1]上海市松江区中心医院神经内科,上海201600 [2]上海市松江区泖港镇社区卫生服务中心全科

出　　处：《脑与神经疾病杂志》2024年第2期120-126,共7页Journal of Brain and Nervous Diseases

基　　金：松江区科技攻关项目(22sjkjGG74)。

摘　　要：目的 调查上海地区汉族人胰岛素抵抗(IR)是否会对急性缺血性脑血管病(AICD)患者血管病变带来影响。方法 选择自2017年1月1日至2022年1月1日,在上海市松江区中心医院住院的AICD,共250例患者,均为上海地区汉族人,根据IR与否,患者被分为2组。(1)IR组:共172例;(2)非IR组:共78例。记录患者的人口学资料和既往史资料。完成血糖、胰岛素、C肽的测量。计算稳态评估模型-胰岛素抵抗(homeostasis model assessment-insulin resistance,HOMA-IR)指数。通过颈动脉、椎动脉超声、头颅磁共振血管成像评估颅内外动脉狭窄或闭塞情况。结果 与非IR组比较,IR组患者葡萄糖(空腹)、胰岛素(空腹)、胰岛素(1h)、胰岛素(2h)、C肽(1h)和C肽(2h)水平较高,差异有统计学意义(P<0.05)。与非IR组比较,IR组患者表现为心源性栓塞型的比例低,差异有统计学意义(P<0.05)。IR组与非IR组患者在大动脉粥样硬化型、小动脉闭塞型、其他明确病因型、不明原因型的比例,差异无统计学意义(P> 0.05)。IR组与非IR组患者在颅内动脉包括前循环血管(包括大脑中动脉、大脑前动脉和颈内动脉脉C2段以远)、后循环血管(包括基底动脉、大脑后动脉)狭窄或闭塞的比例,差异均无统计学意义(P> 0.05)。IR组与非IR组患者在颅外动脉包括右侧颈动脉斑块、左侧颈动脉斑块、双侧颈动脉斑块、颈动脉狭窄或闭塞、颈动脉内膜增厚、椎动脉V1和V2段狭窄或闭塞的比较,差异均无统计学意义(P>0.05)。结论 在上海地区汉族人AICD患者中,IR对TOAST病因学分型中大动脉粥样硬化型、小动脉闭塞型、其他明确病因型、不明原因型的比例均无影响,IR对颅内动脉、颅外动脉狭窄或闭塞的比例均无影响。IR的患者发生心源性栓塞型的比例低。Objective In this study,we retrospectively investigated whether insulin resistance(IR) of the Han nationality in Shanghai would affect vascular lesions in patients with acute ischemic cerebrovascular disease(AICD).Methods A total of 250 patients with AICD who were hospitalized in Shanghai Songjiang District Central Hospital from January 1,2017 to January 1,2022 were selected.Patients were divided into two groups based on whether they were IR or not.One group was the IR group with a total of 172 cases,and the other group was the non-IR group with a total of78 cases.Patient demographics and past history were recorded.Complete the measurement of blood glucose,insulin,and C-peptide.Calculate the homeostasis model assessment-insulin resistance,also known as the HOMA-IR index.Evaluation of intracranial and extracranial arterial stenosis or occlusion by carotid and vertebral arterial ultrasound and cranial magnetic resonance angiography.Results Compared with the non-IR group,the IR group had higher levels of glucose(fasting),insulin(fasting),insulin(1h),insulin(2h),C-peptide(1h) and C-peptide(2h),and the difference was statistically significant Significance(P <0.05).Compared with the non-IR group,the IR group showed a lower proportion of cardioembolic type,the difference was statistically significant(P <0.05).There was no significant difference between the IR group and the non-IR group in the proportion of large artery atherosclerosis,small artery occlusion,other definite etiology,and unknown etiology(P> 0.05).There was no significant difference in the proportions of stenosis or occlusion of the middle cerebral artery,anterior cerebral artery,internal carotid artery beyond the C2 segment,basilar artery and posterior cerebral artery between the IR group and the non-IR group(P> 0.05).There was no statistical difference in right carotid plaque,left carotid plaque,bilateral carotid plaque,carotid artery stenosis or occlusion,carotid intimal thickening,vertebral artery V_1 and V_2 stenosis or occlusion between the two groups

关 键 词：胰岛素抵抗 急性缺血性脑血管病 血糖 胰岛素 颅内动脉 颅外动脉 

分 类 号：R743.32[医药卫生—神经病学与精神病学]