糖尿病与应激性高血糖对急性期脑梗死溶栓效果及预后的影响  

Impact of diabetes and stress hyperglycemia on thrombolytic effect and prognosis in patients with acute cerebral infarction

作　　者：马艳霞[1] 何子骏[2] 王斌[2] 陈少敏[1] 沈春森[2] 

机构地区：[1]北京军区总医院内分泌科,100700 [2]北京军区总医院神经外科,100700

出　　处：《中国脑血管病杂志》2014年第6期289-293,共5页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的观察糖尿病与脑梗死后应激性高血糖对急性脑梗死溶栓效果和短期预后的影响。方法回顾性纳入2012年1月—2013年8月于北京军区总医院接受阿替普酶溶栓治疗的急性期脑梗死(≤4.5h)患者127例。根据有无糖尿病史、入院时随机血糖及7d后口服葡萄糖耐量试验,将其分为糖尿病组(35例),应激性高血糖组(49例)及血糖正常组(43例)。比较溶栓后24 h两组的美国国立卫生研究院卒中量表(NIHSS)评分、血管再通率及90 d的改良Rankin量表(mRS)评分。结果溶栓前,糖尿病组、应激性高血糖组及血糖正常组NIHSS评分分别为(14.2±5.1)、(12.8±5.6)、(13.0±4.6)分,差异无统计学意义(P>0.05);溶栓后24 h,分别为(14.7±6.0)、(11.9±4.9)、(8.0±2.9)分,差异有统计学意义(P<0.05),其中糖尿病组和应激性高血糖组的NIHSS评分与溶栓前比较差异无统计学意义(P>0.05);血糖正常组NIHSS评分低于溶栓前,差异有统计学意义(P<0.05)。溶栓后3组再通良好率分别为54.3%(19例)、57.2%(28例)、67.4%(29例),出血转化率分别为14.3%(5例)、6.1%(3例)、2.3%(1例),差异均无统计学意义。溶栓后90d 3组mRS评分显示,血糖正常组的预后良好率为72.1%(31例),显著高于应激性高血糖组的51.0%(25例)和糖尿病组的28.6%(10例),差异有统计学意义(P<0.05,P<0.01)。应激性高血糖组与糖尿病组比较,差异也有统计学意义(P<0.05)。结论糖尿病与应激性高血糖均对急性期脑梗死溶栓治疗的效果和短期预后有不同程度的不良影响。Objective To observe the impact of diabetes and stress hyperglycemia on thrombolytic effect and short-term prognosis in patients with acute cerebral infarction. Methods A total of 127 patients with acute cerebral infarction （≤4. 5 h） who received thrombolytic therapy with alteplase at General Hospital of Beijing Military Command from January 2012 to August 2013 were enrolled retrospectively. They were divided into three groups：Diabetes group （n=35）,stress hyperglycemia group （n=49）,and normal glucose group （n=43） according to whether they had a history of diabetes,random glucose on admission, and oral glucose tolerance test at day 7. At 24 h after thrombolysis,the National Institute of Health Stroke Scale （NIHSS） scores,recanalization rate,and the modified Rankin Scale （mRS） scores at day 90 were compared between the 2 groups. Results Before thrombolysis,the NIHSS scores of the diabetic group, stress hyperglycemia group,and normal glucose group were 14. 2 ± 5. 1,12. 8 ± 5. 6,and 13. 0 ± 4. 6,respectively （P〉0.05）;at 24 h after thrombolysis,they were 14.7 ±6.0,11.9 ±4.9,and 8.0 ±2.9,respectively （P〈0.05）;compared with before thrombolysis,the NIHSS scores of the diabetes group and the stress hyperglycemia group had no significant change （P〉0. 05）;the NIHSS score of the normal glucose group was lower than before＆amp;nbsp;thrombolysis. There was significant difference （P 〈0. 05）. After thrombolysis,the patients with good recanalization were 54. 3% （n=19）,57. 1% （n=28）,and 67. 4% （n=29）,respectively in the three groups;the hemorrhagic conversion rate was 14. 3% （n=5）,6. 1% （n=3）,and 2. 3% （n=1）,respectively. There were no significant differences. At day 90 after thrombolysis,the mRS scores in the 3 groups showed that the good prognosis rate of the normal glucose group was 72. 1% （n=31）;it was significantly higher than 51. 0% （n=25） of the stress hyperglycemia group and 29. 6% （n=10） of the diabetes group. There were signifi

关 键 词：脑梗死 糖尿病 应激性高血糖 血栓溶解疗法 治疗结果 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R587.1[医药卫生—临床医学]