摘要
目的探讨T2DM合并急性脑梗死(ACI)患者血糖水平及血糖漂移对神经功能缺损及预后的临床意义。方法纳入91例ACI患者,根据有无糖尿病史及入院24h内空腹血糖情况分为糖尿病(A)组28例、单纯应激性高血糖(B)组27例及血糖正常(C)组36例,入院早期行72h动态血糖监测(CGMS),根据《中国脑卒中神经功能缺损评分标准》(CSS),对比3组神经功能缺损程度,并与治疗2周后进行比较。结果 (1)A组女性比例、有陈旧性脑梗死及高血压史患者比例高于B、C组(P<0.05);TG、TC、HDL-C、血清同型半胱氨酸(Hcy)、尿白蛋白/肌酐比值(UACR)、胰岛素抵抗指数(HOMA-IR)、C-RP高于B、C组(P<0.01);(2)HbA1c、餐后2h平均血糖(MPBG)、血糖水平标准差(SDBG)、日内血糖波动幅度(MAGE)和日间血糖波动绝对差(MODD)高于B、C组(P<0.01)。治疗2周后,A组CSS评分高于B、C组(P<0.01);(3)MAGE与CSS评分、Hcy、HOMA-IR均相关(P<0.05);CSS评分与C-RP、Hcy、HOMA-IR相关(P<0.05);多重线性回归分析结果提示,MAGE、C-RP与CSS评分呈独立相关关系。(4)A组病灶以多发脑梗死以及椎-基底动脉系统梗死为主(P<0.01)。结论 T2DM合并ACI患者血糖波动较大,神经功能缺损更严重。血糖波动可能加重ACI进展,与预后相关。
Objective To investigate the significance of glucose level and glucose fluctuation on neurologic impairment during early phase of acute ischemic stroke in patient with T2DM. Methods Ninety-one patients with acute ischemic stroke were included and divided into T2DM （A）group, stress hyperglycemia （B） group and normal glucose （C） group. 72 h continuous glucose monitoring （CGMS）was tested in all subjects Results （1） The ratio of female patients, cerebral infarction history and hypertension history in group A were significantly higher than in group B and C （P^0. 05）. The levels of TC, TG, LDL-C, UACR, HOMA-IR, C reactive protein （C-RP） and homocysteine （Hcy） in group A were significantly higher than in group B and C（P^0. 01）. （2）The levels of HbA1 c, MPBG, standard deviation of blood glucose（SDBG）, mean amplitude of glycemia excursion（MAGE）, and absolute mean of daily difference（MODD） were significantly higher in group A versus group ]3 and C （all P^0. 01）. The CSS scores of the acute ischemic stroke in group A were higher than in B and C groups at 14 d after treatment. （3） MAGE was correlated with CSS score, Hcy, HOMA-IR（P^0. 05）. CSS score were correlated with C-RP, Hcy, HOMA-IR respectively （P^0. 05）. Multiple stepwise regression analysisshowed that MAGE, Hcy were the impact factors of CSS. （4） The lesions of the group A were dominated by multi-cerebral infraction as ~vell as vertebral basilar arterial system（P^0.01）. Conclusion T2DM patients with acute ischemic stroke have the higher blood glucose excursion and the more serious neurological function impairment . Glucose fluctuation may aggravate the progression and prognosis of acute ischemic stroke.
出处
《中国糖尿病杂志》
CAS
CSCD
北大核心
2014年第3期200-203,共4页
Chinese Journal of Diabetes
关键词
脑梗死
急性
糖尿病
2型
血糖波动
Ischemic stroke, acute
Diabetes mellitus, type 2
Blood glucose fluctuation
