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目的探讨血瘦素水平和瘦素受体(LR)基因多态性对胰岛素敏感性影响及与缺血性脑血管病发病的关联。方法对81例动脉粥样硬化性血栓性脑梗死(AC I)、75例腔隙性脑梗死(LI)和36例健康对照者(HC)以放射免疫法检测血胰岛素水平、以ELISA检测血瘦素水平、以PCR-RFLP分析LR基因第6、20外显子碱基变异状况,并根据受试者血糖和胰岛素水平判定其胰岛素敏感指数(ISI)。结果AC I患者血胰岛素水平(6.17±4.33)μIU/m l显著高于对照者(3.49±1.85)μIU/m l(t=4.225,P<0.05),相应其ISI值则明显减低(-3.22±0.79 vs.-2.75±0.54);LI患者血胰岛素水平及ISI值与对照者无明显差异。各组受试者间血瘦素水平无显著差异,但AC I患者中血瘦素水平高于正常均值者的比例(55.56%),也显著高于对照者的比例(38.89%)(x2=7.023,P<0.05)。血瘦素水平与ISI值呈显著负相关。LR基因第6、20外显子各等位基因和基因型分布在各受试组间无明显差别,且各基因型受试者间血瘦素水平也无明显差别。结论AC I发病可能与胰岛素敏感性降低有关,血瘦素水平对胰岛素敏感性有负性影响作用。
Objective To investigate the effect of serum leptin level and leptin receptor (LR) gene polymorphism on insulin sensitivity and its association with ischemic cerebrovascular disease. Methods 81 cases of atherosclerotic cerebral infarction (ACI), 75 cases of lacunar infarction (LI) and 36 healthy controls (HC) were measured by radioimmunoassay of blood insulin levels by ELISA to detect blood Leptin level. PCR-RFLP was used to analyze the mutation status of exon 6 and exon 20 of LR gene. The insulin sensitivity index (ISI) was determined according to the level of blood glucose and insulin. Results The blood insulin level of 6.17 ± 4.33 μIU / ml in ACI patients was significantly higher than that in controls (3.49 ± 1.85 μIU / ml, t = 4.225, P <0.05), and the corresponding ISI value was significantly lower (-3.22 ± 0.79 vs.-2.75 ± 0.54). There was no significant difference in blood insulin level and ISI between LI and control subjects. There was no significant difference in blood leptin levels between the two groups, but the ratio of serum leptin to ACI was higher than that of normal (55.56%) and significantly higher than that of control (38.89%) (x2 = 7.023, P <0.05). Serum leptin levels and ISI values were significantly negatively correlated. There was no significant difference between alleles and genotype distributions of exon 6 and exon 6 of LR gene in each test group, and there was no significant difference in serum leptin level among subjects with each genotype. Conclusion The pathogenesis of ACI may be related to the decrease of insulin sensitivity. The serum leptin level has a negative effect on insulin sensitivity.