CAJ | 학술논문

目的：探讨急性脑梗死患者胰腺内外分泌功能变化及其临床意义。方法选择2010年1月—2015年1月在上海市第十人民医院就诊的急性脑梗死患者93例作为脑梗死组，根据梗死面积分为大面积22例、中面积31例、小面积40例，根据神经功能缺损程度分为轻度32例、中度50例、重度11例；另选择同期在上海市第十人民医院体检健康者30例作为对照组。比较不同梗死面积、神经功能缺损程度脑梗死患者治疗前空腹血糖（FPG）、空腹胰岛素（FINS）、稳态模型的胰岛素抵抗指数（HOMA - IR）、C 肽及粪弹性蛋白酶-1（FE -1），比较脑梗死组治疗前后及对照组 FPG、FINS、HOMA - IR、C 肽及 FE -1。结果大面积和中面积脑梗死患者 FPG、FINS、HOMA - IR 高于小面积脑梗死患者，C 肽及 FE -1低于小面积脑梗死患者（P <0.05）；大面积脑梗死患者 FPG、FINS、HOMA - IR 高于中面积脑梗死患者，C 肽及 FE -1低于中面积脑梗死患者（P <0.05）。重度和中度脑梗死患者 FPG、FINS、HOMA - IR 高于轻度患者，C 肽及 FE -1低于轻度患者（P <0.05）；重度脑梗死患者 FPG、FINS、HOMA - IR 高于中度患者，C 肽及 FE -1低于中度患者（P <0.05）。脑梗死组患者治疗前 FPG、FINS 和 HOMA - IR 高于对照组，C 肽和 FE -1低于对照组（P <0.05）；脑梗死组患者治疗后 FPG、FINS、HOMA - IR、C 肽及 FE -1与对照组比较，差异无统计学意义（P >0.05）；脑梗死组患者治疗后 FPG、FINS、HOMA - IR 低于治疗前，C 肽及 FE -1高于治疗前（P <0.05）。结论急性脑梗死患者存在胰腺内外分泌功能紊乱，且与梗死面积及神经功能缺损程度有关，纠正胰腺内外分泌功能紊乱有助于促进急性脑梗死患者的康复。
목적：탐토급성뇌경사환자이선내외분비공능변화급기림상의의。방법선택2010년1월—2015년1월재상해시제십인민의원취진적급성뇌경사환자93례작위뇌경사조，근거경사면적분위대면적22례、중면적31례、소면적40례，근거신경공능결손정도분위경도32례、중도50례、중도11례；령선택동기재상해시제십인민의원체검건강자30례작위대조조。비교불동경사면적、신경공능결손정도뇌경사환자치료전공복혈당（FPG）、공복이도소（FINS）、은태모형적이도소저항지수（HOMA - IR）、C 태급분탄성단백매-1（FE -1），비교뇌경사조치료전후급대조조 FPG、FINS、HOMA - IR、C 태급 FE -1。결과대면적화중면적뇌경사환자 FPG、FINS、HOMA - IR 고우소면적뇌경사환자，C 태급 FE -1저우소면적뇌경사환자（P <0.05）；대면적뇌경사환자 FPG、FINS、HOMA - IR 고우중면적뇌경사환자，C 태급 FE -1저우중면적뇌경사환자（P <0.05）。중도화중도뇌경사환자 FPG、FINS、HOMA - IR 고우경도환자，C 태급 FE -1저우경도환자（P <0.05）；중도뇌경사환자 FPG、FINS、HOMA - IR 고우중도환자，C 태급 FE -1저우중도환자（P <0.05）。뇌경사조환자치료전 FPG、FINS 화 HOMA - IR 고우대조조，C 태화 FE -1저우대조조（P <0.05）；뇌경사조환자치료후 FPG、FINS、HOMA - IR、C 태급 FE -1여대조조비교，차이무통계학의의（P >0.05）；뇌경사조환자치료후 FPG、FINS、HOMA - IR 저우치료전，C 태급 FE -1고우치료전（P <0.05）。결론급성뇌경사환자존재이선내외분비공능문란，차여경사면적급신경공능결손정도유관，규정이선내외분비공능문란유조우촉진급성뇌경사환자적강복。
Objective To observe the change of pancreatic endocrine and exocrine function of patients with acute cerebral infarction,to explore its clinical significance. Methods A total of 93 patients with acute cerebral infarction were selected as case group in the Tenth People's Hospital of Shanghai from January 2010 to January 2015,and they were divided into subgroups A1(with large - sized infarction,n = 22),A2( with medium - sized infarction,n = 31) and A3( with small -sized infarction,n = 40) according to the infarction sizes,divided into subgroups B1( with mild nerve function defect,n =32),B2(with moderate nerve function defect,n = 50)and B3(with severe nerve function defect,n = 11)according to the degrees of nerve function defect. A total of 30 healthy people were selected as control group in the Tenth People's Hospital of Shanghai at the same time. Fasting plasma glucose( FPG),fasting insulin( FINS),homeostasis model assessment of insulin resistance(HOMA - IR),C - peptide and faecal elastase - 1(FE - 1)were compared. Results FPG,FINS and HOMA -IR of A1 group and A2 group were statistically significantly higher than those of A3 group,while C - peptide and FE - 1 of A1 group and A2 group were statistically significantly lower than those of A3 group(P < 0. 05);FPG,FINS and HOMA - IR of A1 group were statistically significantly higher than those of A2 group,while C - peptide and FE - 1 of A1 group were statistically significantly lower than those of A2 group(P < 0. 05). FPG,FINS and HOMA - IR of B3 group and B2 group were statistically significantly higher than those of B1 group,while C - peptide and FE - 1 of B3 group and B2 group were statistically significantly lower than those of B1 group(P < 0. 05);FPG,FINS and HOMA - IR of B3 group were statistically significantly higher than those of B2 group,while C - peptide and FE - 1 of B3 group were statistically significantly lower than those of B2 group(P <0. 05). Before treatment,FPG,FINS and HOMA - IR of case group were statistically significantly higher than those of control group,while C - peptide and FE - 1 of case group were statistically significantly lower than those of control group(P < 0. 05);after treatment,no statistically significant differences of FPG,FINS,HOMA - IR,C - peptide or FE - 1 was found between case group and control group( P > 0. 05 );FPG,FINS and HOMA - IR of case group after treatment were statistically significantly lower than those before treatment,while C - peptide and FE - 1 of case group after treatment were statistically significantly higher than those before treatment( P < 0. 05). Conclusion Pancreatic endocrine and exocrine dysfunction is common in patients with patients with acute cerebral infarction,and is correlated with infarction sizes and degrees of nerve function defect,respectively;timely conditioning of pancreatic endocrine and exocrine dysfunction is helpful to promote the recovery of patients with acute cerebral infarction.