血糖波动与急性脑梗死患者短期预后关系的研究  

Influence of Blood Sugar Fluctuation on the Short-Term Prognoses of Patients with Acute Cerebral Infarction

作　　者：马艳霞[1] 吕肖锋[1] 焦秀敏[1] 何子骏[2] 王亚双[1] 陈少敏[1] 彭永[1] 丁林[1] 

机构地区：[1]北京军区总医院内分泌科,北京100700 [2]北京军区总医院附属八一脑科医院脑血管病区,北京100700

出　　处：《解放军医药杂志》2014年第8期29-32,36,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：国家科技重大专项子课题(2011ZX09307-001-08)

摘　　要：目的探讨血糖波动对急性脑梗死患者短期预后的影响。方法收集2013年1—11月入住北京军区总医院八一脑科医院的83例急性脑梗死,根据动态血糖监测系统(CGMS)测得的日内平均血糖波动幅度(MAGE)分为高MAGE组(MAGE≥3.9 mmol/L)45例、MAGE正常组(MAGE<3.9 mmol/L)38例,予专科治疗,同时依据合并症予相应的降压、降糖、扩张冠状动脉治疗。比较两组如下项目:有糖尿病病史患者百分率、血压及空腹血糖(FBG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDLC)、血栓素A2(TXA2);动态血糖参数:24 h平均血糖值(24 h MBG)、MAGE、全天血糖标准差(SDBG)、血糖≥7.8 mmol/L的时间在24 h内所占的百分数(PT7.8)、血糖≤3.9 mmol/L的时间在24 h内所占的百分数(PT3.9);入院起90 d内主要不良脑血管事件发生情况、90 d改良RANKIN量表(mRS)评分。对83例90 d mRS评分与各观察指标的相关性进行分析。结果高MAGE组有糖尿病病史者百分率、收缩压(SBP)、FBG、HbA1c、LDL-C、TXA2均显著高于MAGE正常组(P<0.01);高MAGE组24 h MBG、SDBG、PT7.8均显著高于MAGE正常组(P<0.01);高MAGE组90 d内不良脑血管事件发生率及90 d mRS评分显著高于MAGE正常组(P<0.01);90 d mRS评分与TXA2、MAGE呈显著正相关(r=0.828、0.862,P<0.01),TXA2、MAGE与90 d mRS评分呈独立相关(Y=-3.081+0.359TXA2+0.292MAGE)。结论血糖波动明显的急性脑梗死患者预后较差,临床应重视监测此类患者的血糖波动情况,控制血糖波动幅度,以提高疗效,改善预后。Objective To explore the influence of blood sugar fluctuation on short-term prognoses of patients with acute cerebral infarction. Methods A total of 83 patients with acute cerebral infarction from January to November 2013 were divided into high mean amplitude of glycemic excursions （MAGE） group （n=45, MAGE≥3. 9 mmol/L）and normal MAGE group （n=38, MAGE〈3. 9 mmol/L） according the MAGE results by continuous glucose monitoring sys-tem （ CGMS） , and all the patients underwent special treatment and the corresponding treatments of decreasing blood pres-sure and blood sugar, and expansion of coronary artery on the basis of complications at the same time. The levels of per-centage of patients with a history of diabetes, blood pressure, fasting blood glucose （FBG）, glycosylated hemoglobin （HbA1C）, triglyceride （TG）, total cholesterol （TC）, high density lipoprotein cholesterol （HDL-C）, low density lipo-protein cholesterol （ LDL-C） and thromboxane A2 （ TXA2 ） in the two groups were compared; the levels of 24 h mean blood glucose （MBG）, MAGE, standard deviation of blood glucose （SDBG）, percentage of the time of blood glucose value≥7. 8 mmol/L to the 24 h （PT7. 8） and percentage of the time of blood glucose value ≤3. 9 mmol/L to the 24 h （ PT3. 9） in the two groups were also compared;the incidence rate of main adverse cerebrovascular events within 90 d of admission and 90 d of modificatory RANKIN score （ mRS） were also compared. The correlations between 90 d of mRS score and the indexes were analyzed for the 83 patients. Results Compared with those in normal MAGE group, in high MAGE group, the levels of percentage of patients with a history of diabetes, systolic blood pressure （ SBP ） , FBG,HbA1C, LDL-C and TXA2 were significantly higher;the levels of 24 h MBG, SDBG and PT7. 8 were significantly higher （ P〈0. 01）;the levels of incidence rate of main adverse cerebrovascular events within 90 d of admission and 90 d mRS score were significantly high

关 键 词：糖尿病 急性脑梗死 血糖波动 受体 血栓烷A2 预后 

分 类 号：R587.1[医药卫生—内分泌] R743.33[医药卫生—内科学]