关键词: 脑梗死; 非糖尿病; 胰岛素抵抗; 甘油三酯类; 胆固醇; HDL

Abstract: Objective The purpose of this study was to determine the prevalence of insulin resistanceamong nondiabetic patients with acute ischemic stroke and to assess the association between thetriglycerides-HDL-cholesterol ratio (TG:HDL-C) and impaired insulin sensitivity.Methods From August 2008 to December 2009, We enrolled 610 unselected subjects who wereadmitted to the neurological department in TianTan Hospital in this study prospectively. Eligiblesubjects without medical history of diabetes underwent an oral glucose tolerance test (OGTT) 14±3 days after their event. The homeostatic model assessment (HOMA) was used to estimate insulinresistance (HOMA-IR). Risk factors correlated with insulin resistance included blood pressure,body mass index(BMI), HDL cholesterol, triglycerides, triglycerides-HDL-cholesterol ratio (TG:HDL-C), high-sensitivity C-reactive protein (hsCRP), fibrinogen and hyperhomocysteinemia etc.Results In 375 out of 480 ischemic stroke patients without previous DM, glucometabolic statewas determined by oral glucose tolerance test (OGTT). A normal glucose tolerance (NGT) wasidentified in 123 patients, isolated-impaired glucose regulation (I-IFG) in 5 patients, isolatedimpairedglucose tolerance(I-IGT) in 108 patients, combined glucose intolerance (CGI) in 10patients.The propotion of insulin resistance was 8.1% in the NGT group, as compared with 20.0%,17.6%, 30.0% in the I-IFG group, I-IGT group and CGI group respectively (χ2 for trends, P <0.01).TG:HDL-C and hsCRP was associated with an increased risk of impaired insulin sensitivityindependently. The adjusted odds ratio of having insulin resistance was 6.09 [95% confidenceinterval (CI ) 1.43-25.87, P <0.05] for the top TG/HDL level quater and 4.11(95%CI 1.06-15.95,P <0.05) for middle quarters combined than for the bottom quater. The adjusted odds ratio of havinginsulin resistance was 1.19 (95%CI 0.38-3.74, P >0.05) for the top sCRP level quater and 3.98(95%CI1.14-13.89, P <0.05) for middle quarters combined than for the bottom quater.Conclusion Our data revealed that HOMA-estimated insulin resistance and subclinicalinflammation are present in nondiabetic patients with acute ischemic stroke. The TG:HDL-C was apredictor for impaired insulin sensitivity. These findings have important implications for diagnosisand therapy in case that treatment to improve insulin sensitivity is shown to reduce risk forsubsequent stroke and heart disease.

Key words: Brain infarction; Nondiabetic; Insulin resistance; Triglycerides; Cholesterol; HDL