2型糖尿病合并急性脑梗死患者血糖波动与溶栓预后的关系  

Relationship between blood glucose fluctuations and the prognosis of thrombolytic therapy in patients with acute cerebral infarction and type 2 diabetes mellitus

作　　者：马艳霞[1] 吕肖锋[2] 焦秀敏[2] 何子骏[3] 王亚双[2] 陈少敏[2] 

机构地区：[1]山西医科大学第二临床医学院,太原030001 [2]北京军区总医院内分泌科 [3]北京军区总医院神经外科

出　　处：《中国脑血管病杂志》2014年第8期415-419,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：国家科技重大专项子课题(2011ZX09307-001-08)

摘　　要：目的研究血糖波动对急性脑梗死溶栓治疗预后的影响。方法回顾性连续纳入2013年1—11月入住北京军区总医院神经外科(附属八一脑科医院)的83例急性脑梗死患者,给予患者阿替普酶静脉溶栓治疗,剂量为0.9mg/kg体质量。将患者按照有无糖尿病史及入院7 d后口服葡萄糖耐量试验结果分为2型糖尿病合并脑梗死组(DMCI组)47例与非2型糖尿病合并脑梗死组(NDMCI组)36例,入院7d后应用动态血糖监测系统(CGMS)对入选患者进行连续72h的血糖监测。观察并比较两组患者的平均血糖值、血糖水平的标准差、平均血糖波动幅度及随访期间脑出血转化及血管再通情况,并行90d改良Rankin量表(mRS)评分评价其预后。结果 (1)两组急性脑梗死患者动态血糖参数的比较,DMCI组患者24 h平均血糖值、血糖水平标准差、平均血糖波动幅度均高于NDMCI组患者[(8.3±2.6)mmol/L比(5.8±1.3)mmol/L,(2.1±0.4)mmol/L比(1.6±0.6)mmol/L,(4.3±0.8)mmol/L比(3.6±0.5)mmol/L],差异有统计学意义(t值分别为31.419、15.537、15.372,均P<0.01)。(2)DMCI组随访期间发生脑出血转化4例(8.5%),再通良好17例(36.2%),预后良好(90d mRS评分<2分)15例(31.9%);NDMCI组发生脑出血转化1例(2.8%),再通良好21例(58.3%),预后良好21例(58.3%)。两组患者溶栓后再通情况与预后情况比较,差异有统计学意义(P<0.05)。结论伴有2型糖尿病的急性脑梗死患者血糖波动过大,可能是影响其溶栓治疗预后的重要因素。Objective To study the effect of blood glucose fluctuations on the prognosis of thrombolytic therapy in patients with acute cerebral infarction. Methods A total of 83 consecutive patients with acute cerebral infarction admitted to the Department of Neurology,General Hospital of Beijing Military Command （ the Affiliated 81st Brain Hospital ） from January to November 2013 were enrolled retrospectively. They were divided into cerebral infarction with type 2 diabetes mellitus group （DMCI group,n=47） and cerebral infarction without type 2 diabetes mellitus group （NDMCI group,n=36） according to whether they had diabetes mellitus or not and the results of oral glucose tolerance test at day 7 after admission. Continuous glucose monitoring system （ CGMS） was used to monitor glucose for 72 hours at day 7 after admission. The mean blood glucose, standard deviation of blood glucose level, mean blood glucose fluctuation,and hemorrhagic transformation during the follow-up period,as well as vascular recanalization were observed and compared. At day 90,the modified Rankin scale （mRS） score was used to＆amp;nbsp;evaluate the prognosis of the patients. Results （ 1 ） Comparing the dynamic glucose parameters of the patients with acute cerebral infarction in both groups,the mean blood glucose,standard deviation of blood glucose level,mean blood glucose fluctuations at 24 hours in patients of the DMCI group were higher than those of the NDMCI group （ 8 . 3 ± 2 . 6 mmol/L vs. 5 . 8 ± 1 . 3 mmol/L,2. 1 ± 0. 4 mmol/L vs. 1. 6 ± 0. 6 mmol/L,4. 3 ± 0. 8 mmol/L vs. 3. 6 ± 0. 5 mmol/L）. There were significant differences （t=31. 419, 15.537,and 15. 372,respectively;all P〈0. 01）. （2） Four patients （8.5%） in the DMCI group had hemorrhagic transformation during the follow-up period,17 cases （36. 2%） had good recanalization,and 15 cases （31.9%） had good prognosis （the mRS score 〈 2 at day 90）;1 patient （2.8%） in the NDMCI group had hemorrhagic transformation,21 patients （58. 3%�

关 键 词：脑梗塞 糖尿病 2型 血糖 血栓溶解疗法 预后 

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]