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目的观察不同类型急性脑梗死(ACI)患者空腹血清胰岛素(FINS)、C肽(CP)水平变化规律及其与血脂参数的关系。方法采用化学发光免疫分析法测定152例住院ACI患者FINS、CP水平,并按照急性卒中治疗低分子肝素试验(TOAST)病因分型标准分为5大亚型,分析TOAST各亚型FINS、CP水平变化及其与血脂参数的关系。结果本组TOAST各亚型构成比为:不明原因型40.13%,小动脉闭塞型34.21%,心源性栓塞型5.26%,大动脉粥样硬化型15.79%,其他明确病因型4.61%。大动脉粥样硬化型FINS(9.204±5.380)μU ml、CP(2.471±0.893)ng ml水平最高,其次为小动脉闭塞型[(8.237±5.144)μU ml、(1.761±0.975)ng ml],而其他明确病因型[(5.574±2.808)μU ml、(1.611±0.597)ng ml]最低。FINS、CP与TC、TG、LDL、SBP、DBP、年龄显著呈正相关,与HDL呈显著负相关。结论ACI患者FINS、CP水平随TOAST亚型的不同而变化,ACI患者脂质代谢异常与胰岛素抵抗(IR)及高胰岛素血症有关。
Objective To observe the changes of fasting serum insulin (FINS) and C-peptide (CP) levels in patients with different types of acute cerebral infarction (ACI) and its relationship with serum lipid parameters. Methods The levels of FINS and CP in 152 hospitalized ACI patients were determined by chemiluminescence immunoassay and divided into five subtypes according to TOAST classification of acute stroke. The levels of FINS and CP in each subtypes of TOAST were analyzed Changes and its relationship with blood lipid parameters. Results The TOAST subtypes were 40.13% of unknown type, 34.21% of small artery occlusion, 5.26% of cardioembolic type, 15.79% of large atherosclerosis and 4.61% of other definite causes. The atherosclerotic FINS (9.204 ± 5.380) μU ml and CP (2.471 ± 0.893) ng ml had the highest level, followed by arteriolar occlusion [(8.237 ± 5.144) μU ml, (1.761 ± 0.975) ng ml] Other definite etiology [(5.574 ± 2.808) μU ml, (1.611 ± 0.597) ng ml] was the lowest. FINS, CP and TC, TG, LDL, SBP, DBP, age were significantly positively correlated, and HDL was significantly negatively correlated. Conclusion The levels of FINS and CP in patients with ACI vary with the type of TOAST subtypes. The abnormal lipid metabolism in patients with ACI is associated with insulin resistance (IR) and hyperinsulinemia.