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背景:流行病学研究显示胰岛素水平升高和冠状动脉疾患相关,代谢研究也表明胰岛素抵抗、高胰岛素血症和非胰岛素依赖性糖尿病、高血压、肥胖及脂质紊乱密切相关。目的:探讨脑梗死患者体内胰岛素抵抗与红细胞胰岛素受体之间的关系。设计:病例-对照观察。单位:吉林大学中日联谊医院神经内科。对象:选择40例2004-01／10在吉林大学中日联谊医院住院的脑梗死患者。同时选取了30例健康的医护人员作为对照组。方法:检测脑梗死患者和对照者的空腹血糖、血清胰岛素及葡萄糖耐量试验后2 h的血糖、血清胰岛素浓度,并将空腹血糖和血清胰岛素浓度的乘积作为胰岛素抵抗指标。采用改良甘氏法检测红细胞胰岛素受体, 同时分析胰岛素受体数目与胰岛素抵抗指标的关系。主要观察指标:脑梗死组与正常对照组:①空腹及葡萄糖耐量试验后2 h 血糖和血清胰岛素的比较。②胰岛素抵抗指标比较。③红细胞胰岛素受体分析。结果:40例脑梗死患者和30例对照者的数据均进入结果分析,无脱落者。①空腹及葡萄糖耐量试验后2 h血糖和血清胰岛素的比较:脑梗死组空腹血清胰岛素、葡萄糖耐量试验后2 h血糖和胰岛素均大于正常对照组[(13．30±5．15),(9．85±4．36)mU/L,(8．27±1.65),(6．32±1．37)mmol／L, (75．21±21.12),(28．26±6．31)mU／L,P<0．01,P<0．001]。②胰岛素抵抗指标比较:脑梗死组大于正常对照组(68．69±22．91,48．36±10．16,P<0．001)。③红细胞胰岛素受体分析:脑梗死组每个红细胞膜胰岛素高、低两型亲和力受体数目及最大特异性结合率均小于正常对照组[20．30±4．50, 23．80±4．10;2 223．80±509．30,2 610．10±435．10;(10．62±3．55)％, (13．21±2．94)％,P均<0．01];直线回归与相关分析表明脑梗死患者胰岛素高、低两型亲和力受体数目与胰岛素抵抗指标呈负相关(r=-0．458, -0．439,P均<0．01)。结论:脑梗死患者体内存在着胰岛素抵抗;胰岛素受体数目减少在胰岛素抵抗引发的脑梗死中起着重要作用。
BACKGROUND: Epidemiological studies have shown that elevated insulin levels are associated with coronary artery disease. Metabolic studies also suggest that insulin resistance, hyperinsulinemia and non-insulin-dependent diabetes mellitus, hypertension, obesity and lipid disorders are closely related. Objective: To investigate the relationship between insulin resistance and erythrocyte insulin receptor in patients with cerebral infarction. Design: Case-control observation. Unit: Sino-Japanese Friendship Hospital, Jilin University, Department of Neurology. PARTICIPANTS: Forty patients with cerebral infarction hospitalized at Sino-Japanese Friendship Hospital of Jilin University from January to October 2004 were selected. At the same time selected 30 cases of health care workers as a control group. Methods: Fasting blood glucose (FBG), serum insulin and serum insulin levels at 2 h after serum insulin and glucose tolerance test were measured in patients with cerebral infarction and controls. The product of fasting blood glucose and serum insulin concentration was used as an indicator of insulin resistance. The modified Gan’s method was used to detect the erythrocyte insulin receptor, and at the same time the relationship between insulin receptor number and insulin resistance was analyzed. MAIN OUTCOME MEASURES: Cerebral infarction group and normal control group: ① Comparison of blood glucose and serum insulin at 2 h after fasting and glucose tolerance test. ② insulin resistance index comparison. ③ erythrocyte insulin receptor analysis. Results: The data of 40 patients with cerebral infarction and 30 controls were included in the result analysis without any shedding. ① Comparison of fasting blood glucose and serum insulin at 2 h after fasting and glucose tolerance test: fasting serum insulin and blood glucose and insulin at 2 h after glucose tolerance test in cerebral infarction group were significantly higher than those in the normal control group [(13.30 ± 5.15) and (9 .85 ± 4.36 mU / L, (8.27 ± 1.65), (6.32 ± 1.37) mmol / L, (75.21 ± 21.12) and (28.26 ± 6.31) mU /L,P<0.01,P<0.001]. ② Comparison of insulin resistance indicators: cerebral infarction group than the normal control group (68.69 ± 22.91,48.36 ± 10.16, P <0.001). ③ Erythrocyte insulin receptor analysis: Each erythrocyte membrane insulin high infarction group, the number of low-type two types of affinity receptors and the maximum specific binding rate were less than the normal control group [20.30 ± 4.50, 23.80 ± 4. 10; 223.80 ± 509.30,2 610.10 ± 435.10; (10.62 ± 3.55)%, (13.21 ± 2.94)%, P <0.01]; Linear regression and correlation analysis showed that there was a negative correlation between the number of high affinity insulin receptor and the number of low affinity insulin receptor in patients with cerebral infarction (r = -0.458, -0.439, P <0.01). Conclusion: Insulin resistance exists in patients with cerebral infarction. The decrease of insulin receptor plays an important role in cerebral infarction induced by insulin resistance.