缺血性脑卒中老年患者血浆血小板活化因子乙酰水解酶与胰岛素抵抗关系的研究

摘要

Objective To investigate the relationship between plasma platelet-activating factor-acetylhydrolase(PAF-AH )and insulin resistance,glucose and lipid metabolism in elderly patients with ischemic stroke.Methods A total of 100 elderly patients with ischemic stroke were selected.The homeostasis model assessment insulin resistance(HOMA-IR)index was calculated based on the patients'blood glucose and insulin levels.Fifty cases were included in the IR group and 50 cases were in the non-IR group.In the same period,30 older people with normal physical examination were selected as normal control group.Fasting blood glucose,fasting insulin, HOMA-IR,and triglycerides(TG)levels were compared among the three groups.The activity of PAF-AH under different binding states in each group of patients was compared.The PAF-AH activity of different combinations of patients in each group was compared.The activity ratio of L-PAF-AH/H-PAF-AH activity and the characteristics of glucose lipid metabolism and clinical data were compared,and the correlation analysis was conducted.Results The average fasting blood glucose,fasting insulin,HOMA-IR and TG levels in IR group were significantly higher than those in non-IR group and control group(P<0.05).The levels of low density lipoprotein cholesterol(LDL-C)and total cholesterol(TC)in the IR group were higher than those in the control group(P<0.05).The levels of fasting blood glucose,fasting insulin,LDL-C,TC and TG in non-IR group were higher than those in control group(P<0.05).The plasma L-PAF-AH, PAF-AH activity and L-PAF-AH/H-PAF-AH activity ratio in IR group were higher than those in non-IR group and control group(P<0.05).The Pearson correlation analysis found that plasma L-PAF-AH/H-PAF-AH activity ratio were positively correlated with HOMA-IR,fasting blood glucose,fasting insulin,TG,LDL-C,TC level and aortic sclerosis in all patients(r=0.654, 0.597,0.532,0.442,0.612,0.336,0.466,P<0.05).There was a negative correlation with HDL-C(r=-0.571,P<0.05).Conclusion The increase of plasma PAF-AH,L-PAF-AH and L-PAF-AH/H-PAF-AH ratio in patients with ischemic stroke may be associated with IR, atherosclerosis,chronic inflammation and oxidative stress in human body,which is a risk factor for ischemic stroke patients.The L-PAF-AH/H-PAF-AH activity ratio may be a monitoring indicator of chronic inflammatory state in patients with ischemic stroke with IR or arteriosclerosis.%目的 探讨缺血性脑卒中老年患者血浆血小板活化因子乙酰水解酶(platelet-activating factor-acetylhydrolase,PAF-AH)与胰岛素抵抗、糖脂代谢水平的关系.方法 选取100例老年缺血性脑卒中患者,根据患者血糖和血胰岛素水平计算稳态模型胰岛素抵抗指数(homeostasis model assessment insulin resistance,HOMA-IR)分为 IR组50例和非 IR组50例,另选同期体检正常老年人30例为正常对照组;检测并对比3组空腹血糖、空腹胰岛素、HOMA-IR、三酰甘油(triglycerides,TG)水平,比较各组血浆中不同结合状态的 PAF-AH 活性并进行患者L-PAF-AH/H-PAF-AH 活性比值与糖脂代谢水平和临床资料特征的相关性分析.结果 IR 组空腹血糖、空腹胰岛素、HOMA-IR 及 TG 水平均高于非 IR 组和对照组(P<0.05);IR 组低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)和总胆固醇(total cholesterol,TC)水平分均高于对照组(P<0.05);非 IR组空腹血糖、空腹胰岛素、HOMA-IR、TG、TC和 LDL-C水平均高于对照组(P<0.05).IR组血浆中 PAF-AH、L-PAF-AH活性和 L-PAF-AH/H-PAF-AH 活性比值均高于非 IR组和对照组(P<0.05).经 Pearson相关分析,患者血浆中平均 L-PAF-AH/H-PAF-AH 活性比值与 HOMA-IR、空腹血糖、空腹胰岛素、TG、LDL-C、TC、大动脉硬化均呈正相关(r=0.654、0.597、0.532、0.442、0.612、0.336、0.466,P<0.05),而与 HDL-C呈负相关(r=-0.571,P<0.05).结论 缺血性脑卒中患者血浆内PAF-AH、L-PAF-AH 及L-PAF-AH/H-PAF-AH 活性比值升高可能与IR、大动脉硬化、体内慢性炎症及氧化应激状态相关,是缺血性脑卒中患者的危险因素,L-PAF-AH/H-PAF-AH 活性比值有可能成为伴有 IR或大动脉硬化的缺血性脑卒中患者慢性炎症状态的监测指标.