糖代谢异常合并脑梗死患者脂联素水平的变化及其临床意义

摘要

目的：比较不同糖代谢状态合并脑梗死患者的血浆脂联素（ADPN）水平的变化，探讨脂联素在糖尿病合并脑梗死发病中的作用。方法：收集2014年1月～2014年12月在广东省中山市中医院内分泌科及神经内科住院的脑梗死患者502例，分为单纯脑梗死组（CI 组）198例、糖耐量异常合并脑梗死组（IGT ＋ CI 组）145例、糖尿病合并脑梗死组（DM ＋ CI 组）159例及健康对照组（NC 组）150例。登记所有受试者的相关危险因素，对比不同组血浆脂联素、血糖、血脂、高敏 C 反应蛋白（hs - CRP）及胰岛素抵抗指数（HOMA - IR）水平。结果：不同组患者基线资料比较，健康对照组高血压病发生率较低，存在统计学差异，其他危险因素均无差异。4组患者在胆固醇及高密度胆固醇水平方面比较，差异无统计学意义（P ＞0.05），但三酰甘油水平、低密度胆固醇水平、糖化血红蛋白、C -反应蛋白、胰岛素抵抗指数及脂联素水平方面，均存在统计学差异（P ＜0.05）。结论：脑梗死患者血浆 ADPN 浓度降低，合并糖代谢异常的脑梗死患者血浆 ADPN 浓度更低，且随着糖代谢异常的程度加重降低更为显著，提示血浆 APN 水平降低可能在糖尿病合并脑血管病变中发挥重要作用。%Objective To compare the level of adiponectin among various state of glycometabolism complicated with acute cerebral ischemia,and to investigate the role of adiponectin on diabetes mellitus complicated with cerebral infarction. Method We recruited 502 patients in Department of Neurology,Endocrinology of Zhongshan Hospital of TCM from January 2014 to December 2014,and the patients were divided into cerebral ischgemia group(CI group,n = 198),glucose tolerance abnormal complicated with cerebral ischemia(IGT + CI group,n = 145),diabetes mellitus complicated with cerebral ischemia(DM + CI group,n = 159) and healthy control(NC group,n = 150). We observed and compared the related risk factors among different groups,including adiponectin,glucose,hs - CRP,blood lipid,homeostasis model of assessment for insulin resistence index( HOMA - IR) . Results The baseline data among 4 groups were compared,and the results indicated that incidence of hypertension of control group was lower,but the other risk factors showed no difference among different groups. The level of total cholesterol and high -density lipoprotein cholesterol among 4 groups showed no significant difference(P > 0. 05). However,the level of triglyceride,low- density lipoprotein cholesterol,glycosylated hemoglobin,C - reactive protein,and HOMA - IR and adiponectin were statistical difference(P < 0. 05). Conclusion The plasma concentration of adiponectin among patients of cerebral infarction decreases com-pared with healthy control. The level of adiponectin reaches a propotional decrease with deterioration of glycometabolism,so the lower level of adiponectin may be involved in the mechanism of diabetes mellitus complicated with cerebral infarction.