慢性心力衰竭患者血清中胰岛素、C肽、血糖水平的变化及其临床意义

Clinical significance of serum insulin,C peptide and sugar in chronic congestive heart failure

  • 摘要: 采用放射免疫法对40例不同病因不同程度的慢性心血衰竭患者(CHF)和11例对照者进行空腹血清中胰岛素、C肽和血糖水平的测定后显示CHF患者普遍存在血清胰岛素水平减低的现象,减低的程度与原发病无关却随CHF程度加重而胰岛素水平减低越明显,但代表胰岛素内源性水平的C肽在不同病因及不同程度CHF间均与对照组无显著性差别。对在CHF治疗中所应用的可能影响胰岛素水平的主要药物血管紧张素转换酶抑制剂和钙拮抗剂进行了统计分析后,发现两种药物的应用不是导臻本组CHF患者血清胰岛素减低的原因。作者认为主要与心肌保持作用有关,机体对胰岛素的利用大于分泌而引起。本组结果的临床意义在于:(1)CHF患者普遍存在血清胰岛素水平随CHF程度加重而减低的现象,原因主要是代谢障碍的心肌利用胰岛素增加而致,这为临床应用葡萄糖-胰岛素-钾溶液治疗CHF提供了依据;(2)测定CHF患者空腹血清中胰岛素水平及其动态变化有助于判断心力衰竭的程度及变化

     

    Abstract: Fasting serum insulin,C peptide and glucose levels were mearsured in 40 patients suffering from chronic congestive heart failure (CHF) and 11 healthy persons.The CHF was the result of coronary atherosclerosis,rheumatic valve disease,hypertension and cardciomyopathy.Serum insulin levels were decreased in all chronic CHF patients,and the levels of insulin were directly proportional to the severity of chronic heart failure.The severer the CHF,the lower the serum insulin levels.The seurm insulin levels in the controls were 8.684 7±0.606 1 mU/L and this confrms to other domestic and iverseas reports.In CHF,degree Ⅰ、Ⅱ、Ⅲ were 6.890 5±0.601 4 mU/L,3.895 6±0.319 3 mU/L,0.899 6±0.187 3 mU/L respectively.However,the seurm C peptide levels which represent initial insulin secreting function of islets of Langerhans and gluccse levels had no significant difference between the control group and the patient group.The seurm insulin levels in those patienis who were treated with angiotensin converting ensyme inhibitors and calcium blockers which were reported to affect insulin levels revealed no significant difference compared with those not treated.The result of this study shows that the reduction of serum insulin levels in CHF is not caused by defect of secreting function of islets of Langerhans but by over insulin consumption in the jeopardized myocardium.It is mainly related to myocardial protections The clinical significance of this study might be:(1)Decrease of serum insulin levels is a common phenomenon in chronic CHF,and it is due to insulin iver consumption in the jeopardized myocardium,this offers us theoretical support to treat CHF with glucose insulin potassium solution;(2)Measuring the serum insulin levels in CHF could help to evaluate the severity of CHF.

     

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