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目的探讨2型糖尿病并急性脑梗死患者血清胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)水平与神经功能缺损及临床预后的相关性。方法 2型糖尿病并急性脑梗死患者32例(脑梗死+糖尿病组)、急性脑梗死非糖尿病患者33例(脑梗死组)、单纯2型糖尿病患者33例(糖尿病组)和体检健康者30例(对照组),脑梗死+糖尿病组和脑梗死组分别于起病后3、14d检测血清IGF-1水平,采用美国国立卫生院卒中量表(the National Institutes of Health Stroke Scale,NHSS)评分评估神经功能缺损程度,90d行改良Rankin量表(modified Rankin scale,MRS)评分判断预后情况;糖尿病组和对照组分别于入院后3、14d检测血清IGF-1水平,并与脑梗死+糖尿病组、脑梗死组进行比较。结果脑梗死+糖尿病组3、14d时血清IGF-1水平[(88.08±24.22)、(114.43±24.54)μg/L]低于脑梗死组[(99.73±20.25)、(125.89±20.35)μg/L]、糖尿病组[(106.45±19.29)、(127.14±19.11)μg/L]和对照组[(152.50±28.56)、(152.56±26.40)μg/L](P<0.01),脑梗死组与糖尿病组IGF-1水平低于对照组(P<0.05),脑梗死组与糖尿病组比较差异无统计学意义(P>0.05);脑梗死+糖尿病组3、14d时NIHSS评分(7.44±2.34、4.34±1.86)及90d时MRS评分(2.22±1.21)均高于脑梗死组(5.48±1.87、2.61±1.87,1.64±0.99)(P<0.05);3、14d时NIHSS评分与3、14d时脑梗死+糖尿病组(r=-0.934,P=0.004;r=-0.821,P=0.000)和脑梗死组(r=-0.807,P=0.008;r=-0.653,P=0.005)IGF-1水平呈明显负相关,90d时MRS评分与3、14d时脑梗死+糖尿病组(r=-0.309,P=0.031;r=-0.306;P=0.029)和脑梗死组(r=-0.308,P=0.045;r=-0.369,P=0.037)IGF-1水平呈明显负相关。结论 2型糖尿病并急性脑梗死患者血清IGF-1水平可用于判断病情轻重及临床预后。
Objective To investigate the relationship between serum insulin-like growth factor-1 (IGF-1) level, neurological deficit and clinical prognosis in type 2 diabetic patients with acute cerebral infarction. Methods Thirty-two patients with type 2 diabetes mellitus and acute cerebral infarction (cerebral infarction + diabetes mellitus group), 33 patients with non-diabetic acute cerebral infarction (cerebral infarction group), 33 patients with simple type 2 diabetes mellitus (DM group) and 30 healthy subjects (Control group). Serum IGF-1 levels were measured at 3 and 14 days after onset in cerebral infarction + diabetes mellitus group and cerebral infarction group, respectively, and were assessed by the National Institutes of Health Stroke Scale (NHSS) score The degree of neurological deficit and the modified Rankin scale (MRS) score were used to evaluate the prognosis in 90 days. The levels of serum IGF-1 in diabetes mellitus group and control group were respectively measured at 3 and 14 days after admission, and compared with cerebral infarction + diabetes mellitus group, Cerebral infarction group for comparison. Results The level of serum IGF-1 at 3 and 14 days in cerebral infarction + diabetes group was significantly lower than that in cerebral infarction group [(88.08 ± 24.22) vs (114.43 ± 24.54) μg / L] (99.73 ± 20.25 vs 125.89 ± 20.35 μg / (P <0.01). Compared with the control group [(152.50 ± 28.56), (152.56 ± 26.40) μg / L] in the diabetic group [(106.45 ± 19.29), (127.14 ± 19.11) μg / The level of IGF-1 in diabetes mellitus group was lower than that in control group (P <0.05), while there was no significant difference between cerebral infarction group and diabetes mellitus group (P> 0.05). The NIHSS score of cerebral infarction + diabetes mellitus group at 3 and 14 days was 7.44 ± 2.34 4.34 ± 1.86) and MRS score (2.22 ± 1.21) at 90 days were significantly higher than those in cerebral infarction group (5.48 ± 1.87,2.61 ± 1.87,1.64 ± 0.99, P <0.05) The levels of IGF-1 in cerebral infarction + diabetes group (r = -0.934, P = 0.004; r = -0.821, P = 0.000) and cerebral infarction group (r = -0.807, P = 0.008; There was a significant negative correlation between MRS score and cerebral infarction at 90 days and cerebral infarction + diabetes group (r = -0.309, P = 0.031; r = -0.306; P = 0.029) and cerebral infarction group (r = -0.308, P = 0.045; r = -0.369, P = 0.037) showed a significant negative correlation. Conclusion Serum IGF-1 levels in patients with type 2 diabetes mellitus and acute cerebral infarction can be used to determine the severity and clinical prognosis.