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目的探讨糖尿病合并急性期脑卒中患者血糖变异性与短期不良预后的相关性。方法选取糖尿病合并急性期脑卒中患者155例,根据血糖水平标准差(GluSD)分为血糖变异组(GluSD≥1.4mmol/L)92例和非血糖变异组(GluSD<1.4mmol/L)63例。另根据GluSD水平将血糖变异组进行三分位分组,从低到高分别为低分位(GluSD 1.42~1.87mmol/L)组、中分位(GluSD 1.43~2.32mmol/L)组及高分位(GluSD 2.33~2.87mmol/L)组。各组入院后均接受72h动态血糖监测(CGM),计算CGM指标,以美国国立卫生院卒中(NIHSS)评分、蒙特利尔认知评估量表(MoCA)及Barthel指数评估短期内的预后状况。采用Logistic回归分析糖尿病合并急性期脑卒中患者短期不良预后的影响因素。结果血糖变异组FPG[(8.49±1.71)vs(7.33±1.58)mmol/L]、HbA_1c[(8.61±0.55)%vs(7.14±0.43)%]、GluAve、GluMAGE、GluGLI及GluCV均高于非血糖变异组(P<0.05或P<0.01);高分位组GluAve、GluMAGE、GluGLI及GluCV均高于低分位组(P<0.05),且随GluSD水平升高,NIHSS评分升高,MoCA评分及Barthl指数降低(P<0.05)。Logistic回归分析发现,年龄、HbA_1c、GluAve、GluCV及NIHSS评分是糖尿病合并急性期脑卒中预后的危险因素(P<0.05或P<0.01)。结论糖尿病合并急性期脑卒中患者血糖变异性与不良预后相关,提示减少血糖波动可能更有利于改善预后。因此,在降低血糖水平的同时,需有效控制血糖波动。
Objective To investigate the correlation between the blood glucose variability and short-term adverse prognosis in acute stroke patients with diabetes mellitus. Methods A total of 155 stroke patients with acute exacerbation of diabetes mellitus were enrolled in this study. According to the standard deviation of blood glucose level (GluSD), 92 patients with GluSD≥1.4mmol / L and 63 patients with non-hyperglycemia (GluSD <1.4mmol / L) . According to the level of GluSD, the blood glucose variation group was divided into three quartiles, ranging from low to high (GluSD 1.42-1.87mmol / L), middle (Glu 1.43-2.32mmol / L) Position (GluSD 2.33 ~ 2.87mmol / L) group. All patients underwent 72-h dynamic glucose monitoring (CGM) after admission, and CGM indicators were calculated. The NIHSS score, Montreal Cognitive Assessment Scale (MoCA) and Barthel Index were used to evaluate the short-term prognosis. Logistic regression analysis was used to analyze the influencing factors of short-term adverse prognosis in patients with acute cerebral infarction. Results The levels of GluAve, GluMAGE, GluGLI and GluCV in blood glucose variant group were significantly higher than those in non-glucose group (8.49 ± 1.71 vs 7.33 ± 1.58 mmol / L, HbA 1c [(8.61 ± 0.55)% vs 7.14 ± 0.43 (P <0.05 or P <0.01). GluAve, GluMAGE, GluGLI and GluCV in the high-titer group were significantly higher than those in the low-titer group (P <0.05). NIHSS score increased as GluSD level increased and MoCA Scores and Barthl index decreased (P <0.05). Logistic regression analysis showed that age, HbA1c, GluAve, GluCV and NIHSS scores were risk factors of stroke prognosis in patients with acute exacerbation of diabetes mellitus (P <0.05 or P <0.01). Conclusions The blood glucose variability in acute stroke patients with diabetes mellitus is associated with poor prognosis, suggesting that reducing blood glucose may be more beneficial to improve prognosis. Therefore, in reducing blood sugar levels, the need to effectively control blood sugar fluctuations.