摘要
目的探讨空腹血糖(FPG)与急性缺血性脑卒中患者神经功能的相关性。方法回顾性分析自2013年11月至2016年10月发病24 h内入住首都医科大学宣武医院的缺血性脑卒中患者3338例。测量患者的收缩压(SBP)和舒张压(DBP)。检测患者的FPG、餐后2 h血糖、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、糖化血红蛋白(HbA1c)、FPG、血肌酐(serum creatinine,Scr)、尿素、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、同型半胱氨酸(Hcy)以及血浆纤维蛋白原(Fg)。采用美国国立卫生研究院卒中量表(NIHSS)、格拉斯哥昏迷量表(GCS)、改良Rankin量表(MRS)进行神经功能评分。根据患者入院FPG水平分为3组:血糖正常组(FPG<6.1 mmol/L,且无糖尿病病史,1507例),FPG受损组(6.1 mmol/L≤FPG<7.0 mmol/L,1002例),糖尿病组(FPG≥7.0 mmol/L或既往有糖尿病病史,829例)。根据NIHSS评分将所有患者分为神经功能缺损组(NIHSS评分>1分,1906例)和神经功能正常组(NIHSS评分≤1分,1432例)。组间比较采用方差分析、t检验和χ^(2)检验。采用Pearson相关分析法分析FPG与神经功能评分的相关性。采用多因素logistic回归分析法分析脑卒中患者神经功能的影响因素。结果与血糖正常组和FPG受损组相比,糖尿病组患者的SBP、DBP、FPG、餐后2 h血糖、ALT、AST水平升高,Scr、尿素、TG水平降低,差异均具有统计学意义(P<0.05);与血糖正常组相比,FPG受损组的SBP、DBP、FPG、餐后2 h血糖、ALT水平升高,AST、Scr、尿素、TG水平降低,差异均具有统计学意义(P<0.05)。3组患者的NIHSS、MRS、GCS评分比较差异均具有统计学意义(P<0.001),其中,糖尿病组的NIHSS、MRS评分明显高于FPG受损组,GCS评分明显低于FPG受损组;FPG受损组的NIHSS、MRS评分明显高于血糖正常组,GCS评分明显低于FPG受损组(均P<0.05)。FPG与NIHSS、MRS评分呈正相关(r=0.80,P<0.05;r=0.84,P<0.05),与GCS评分呈负相关(r=-0.83,P<0.05)。多因素logistic回归分析结果显示,年龄、餐后2 h血糖、使用降糖药、FPG均与脑卒中患者神经功能有关(P<0.05)。结论FPG与急性缺血性脑卒中患者神经功能评分有显著相关性,FPG高的患者神经功能损伤程度更重、神经功能恢复状态及意识状态更差。
Objective To investigate the correlation between fasting blood glucose(FPG)and neurological function in patients with acute ischemic stroke.Methods A retrospective analysis was performed on 3338 stroke patients admitted to Xuanwu Hospital of Capital Medical University within 24 hours of onset from November 2013 to October 2016.Systolic blood pressure(SBP)and diastolic blood pressure(DBP)were measured.FPG,2 hours postprandial-based blood glucose,aspartate aminotransferase(AST),alanine aminotransferase(ALT),glycated hemoglobin A1c(HbA1c),serum creatinine(Scr),urea,total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),homocysteine(Hcy),plasma fibrinogen(Fg)were detected.National institutes of health stroke scale(NIHSS),Glasgow coma index(GCS)and modified Rankin scale(MRS)were used to evaluate neurological function.Patients were divided into three groups according to different FPG levels on admission:normal blood glucose group(FPG<6.1 mmol/L,no history of diabetes,1507 cases),FPG impaired group(6.1 mmol/L≤FPG<7.0 mmol/L,1002 cases),diabetes group(FPG≥7.0 mmol/L or previous history of diabetes,829 cases).According to NIHSS score,all patients were divided into neurological impairment group(NIHSS score>1 point,1906 cases)and normal neurological function group(NIHSS score≤1 point,1432 cases).The analysis of variance,t test,andχ^(2) test were used for comparison between groups.Pearson correlation analysis was used to analyze the correlation between FPG and neural function score.Multivariate logistic regression analysis was used to analyze the influencing factors of neurological function in acute ischemic stroke patients.Results Compared with the normal blood glucose group and the impaired FPG group,SBP,DBP,FPG,ALT and AST were increased and the indexes of Scr,urea and TG were decreased in the diabetic group,the differences were statistically significant(all P<0.05).Compared with the normal blood glucose group,the SBP,DBP,FPG and ALT in the FPG impaired group were increased,while the AST,Scr,urea and TG were decreased,and the differences were statistically significant(all P<0.05).There were statistically significant differences in NIHSS,MRS and GCS scores among the three groups(all P<0.001).NIHSS and MRS scores in the diabetic group were significantly higher than those in the FPG impaired group,and GCS scores were significantly lower than those in the FPG impaired group(all P<0.001).NIHSS and MRS scores in the FPG impaired group were significantly higher than those in the normal blood glucose group,and GCS scores were significantly lower than those in the FPG impaired group(all P<0.05).FPG was positively correlated with NIHSS and MRS scores(r=0.80,P<0.05;r=0.84,P<0.05),was negatively correlated with GCS scores(r=-0.83,P<0.05).Multivariate logistic regression analysis showed that age,2 hours postprandial-based blood glucose,hypoglycemic agents and FPG were all related to neurological function in stroke patients(P<0.05).Conclusions There is a significant correlation between FPG and neurological function score in patients with acute ischemic stroke.Patients with high FPG have more severe neurological function injury,poorer neurological function recovery state and worse consciousness state.
作者
赵蕾
贾茜
李小莹
孙丽娜
穆志静
付俊玲
修双玲
Zhao Lei;Jia Qian;Li Xiaoying;Sun Lina;Mu Zhijing;Fu Junling;Xiu Shuangling(Department of Endocrinology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Medical Affairs,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Beijing Municipal Geriatric Medical Research Center,Beijing 100053,China)
出处
《中华糖尿病杂志》
CAS
CSCD
北大核心
2023年第5期402-408,共7页
CHINESE JOURNAL OF DIABETES MELLITUS
基金
北京市属医院科研培育计划项目(PX2020034)
北京市属医学科研院所公益发展改革试点项目(京医研2021-8)
糖尿病防治研究北京市重点实验室开放基金(10025220102)
北京市属医院科研培育计划项目(PG2023016)。
关键词
卒中
空腹血糖
神经功能
相关性
Stroke
Fasting plasma glucose
Neurological function
Correlation
