糖化血红蛋白预测2型糖尿病并缺血性脑卒中患者再次脑血管事件价值  

Value of glycosylated hemoglobin A_1c level to predicting recurrent cerebrovascular event in patients with type 2 diabetes mellitus complicated with ischemic stroke

作　　者：刘岩[1] 乔洪波[1] 常铮[1] 

机构地区：[1]吉林市中心医院神经外科,吉林吉林132001

出　　处：《中华实用诊断与治疗杂志》2015年第9期918-920,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：吉林市科技发展项目(201339089)

摘　　要：目的探讨糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)在预测2型糖尿病并缺血性脑卒中患者发生再次脑血管事件(recurrent cerebrovascular event,RCE)中的价值。方法 2型糖尿病并缺血性脑卒中患者146例,依据入院时HbA1c水平分为高水平组(HbA1c≥6.0%)87例和正常组(HbA1c<6.0%)59例,比较2组入院次日空腹血糖(fasting plasma glucose,FPG)、餐后2h血糖(2hpostprandial plasma glucose,PPG)、总胆固醇(total cholesterol,TC)、三酰甘油(triacylglycerol,TG)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)水平和入院时神经功能损伤程度;2组均给予脱水、降压、改善脑循环、营养神经、控制血糖等治疗,连续治疗3周后评定疗效;随访24个月,统计RCE发生情况,比较发生RCE者和未发生RCE者入院时HbA1c水平。结果高水平组入院次日FPG[(8.94±2.33)mmol/L]、PPG[(13.07±3.82)mmol/L]、TC[(6.09±1.37)mmol/L]、TG[(1.92±0.53)mmol/L]、LDL-C[(4.11±1.13)mmol/L]水平高于正常组[FPG(6.72±2.61)mmol/L,PPG(9.36±4.11)mmol/L,TC(4.95±1.00)mmol/L,TG(1.14±0.33)mmol/L,LDL-C(2.98±1.05)mmol/L],HDL-C水平[(1.03±0.27)mmol/L]低于正常组[(1.45±0.34)mmol/L](P<0.05);高水平组入院时中重度神经功能损伤发生率(87.36%)高于正常组(38.98%)(P<0.05);2组连续治疗3周后,高水平组好转率(75.86%)低于正常组(94.92%)(P<0.05);随访24个月,146例中45例发生RCE,发生RCE者入院时HbA1c水平[(9.24±2.13)%]高于未发生RCE者[(6.07±1.86)%](P<0.05)。结论 HbA1c水平增高的2型糖尿病并缺血性脑卒中患者易发生RCE,检测入院时HbA1c水平有助于预测其发生RCE的风险。Objective To explore the value of glycosylated hemoglobin A1c （HbA1c） to predicting the recurrent cerebrovascular event （RCE） in patients with type 2 diabetes mellitus （T2DM） complicated with ischemic stroke. Methods A total of 146 patients with T2DM complicated with ischemic stroke were divided into high HbAlc group （HbA1c≥6.0%） （n=87） and normal group （HbA1c〈6.0%） （n=59） according to the HbAlc level at admission. The levels of fasting plasma glucose （FPG）, 2 h postprandial plasma glucose （PPG）, total cholesterol （TC）, triaeylglycerol （TG）, low density lipoprotein-cholesterol （LDL-C） and high density lipoprotein-cholesterol （HDL-C） one day after admission, as well as the degree of neurological damage at admission were compared between two groups. Both two groups received dehydration, antihypertension, improving cerebral circulation, nerve nutrition and plasma glucose controlling therapy. After continuous treatment for 3 weeks, the therapeutic effect was assessed. After follow-up for 24 months, the incidence of RCE was calculated, and HbA1c levels at admission were compared in patients with and without RCE. Results The levels of FPG （（8. 94±2. 33） mmol/L）, PPG （（13. 07±3. 82） mmol/L）, TC （（6. 09±1. 37） mmol/L）, TG （（1.92±0.53） retool/L） and LDL-C （（4. 11±1. 13） mmol/L） were higher in high HbAlc group than those in normal group （FPG： （6. 72±2. 61） mmol/L, PPG.. （9.36±4. 11） mmol/L, TC： （4.95±1.00） mmol/L, TG： （1.14±0.33） mmol/L, LDL-C： （2.98±1.05） mmol/L）, and HDL-C was lower in high HbAlc group （（1.03± 0.27） mmol/L） than that in normal group （（1.45±0.34） mmol/L） one day after admission （P〈0.05）. The incidence of moderate and severe neurological damage was higher in high HbAlc group （87. 36%） than that in control group （38.98%） at admission （P〈0.05）. After 3-week treatment in both groups, the improvement rate was 75.86% in high HbA1c group,

关 键 词：糖尿病并缺血性脑卒中 糖化血红蛋白 再次脑血管事件 

分 类 号：R587.2[医药卫生—内分泌] R743.3[医药卫生—内科学]