糖化血红蛋白与脑出血患者预后的关系  

Association between hemoglobin A1c and outcomes of patients with spontaneous intracerebral hemorrhage

作　　者：张广慧[1] 何明利[1] 徐艳[1] 何效兵[1] 孟品 刘娜[1] 吴方荣[1] 

机构地区：[1]连云港市第一人民医院神经内科,222002

出　　处：《中华神经医学杂志》2015年第10期1018-1022,共5页Chinese Journal of Neuromedicine

基　　金：江苏省卫生厅资助项目（Y2013032）;连云港市卫生科技项目（1403）

摘　　要：目的观察自发性脑出血（sICH）发作前的血糖水平和SICH预后之间的关系。方法收集连云港市第一人民医院神经内科自2011年1月至2013年9月收治的288例幕上sICH患者（均为发病24h内入院）临床资料进行研究。以糖化血红蛋白（HbA1c）代表脑出血发病前的血糖水平。根据HbAIc值水平（〈6％、6．1％～7％、7．1％～8％及≥8％）将患者分为4组，比较4组患者美国国立卫生研究院卒中量表（NIHSS）评分、血肿体积、改良Rankin量表评分（mRS）等临床资料的差异。同时根据出血量大小（≤25mL或〉25mL）分为小血肿组和大血肿组，根据mRS评分（≤2或〉2）分为预后良好组和预后不良组，比较不同分组患者临床资料特点。采用Logistic回归分析来确定与血肿体积和mRS相关的独立危险因素。结果4组患者糖尿病患者数、血肿体积、NIHSS评分、mRS评分差异有统计学意义（P〈0．05）。人院血糖、HbA1c与血肿体积呈正相关关系（r=0．085，p=0．027；r=0．164，P=0．014）；年龄、HbA1c与mRS评分呈正相关关系（r=0．027，P=0．019；r=0．199，P=0．003）。HbA1c同时与血肿体积及mRS评分呈正相关关系（r=0．164，P=0．014；r=0．199，p=0．003）。结论HbA1c是脑出血患者预后差的独立危险因素。与血糖水平相比，HbAlc可以作为一个更好的预测脑出血预后的指标。Objective Admission hyperglycemia is thought to be related to poor neurological function and high mortality in patients with spontaneous intracerebral hemorrhage （slCH）. However, it is not known whether preictal glycemic status affects fimctional outcome of slCH. The study is aimed to disclose the association between preictal glycemic status and neurological outcomes in patients with acute slCH. Methods Three hundred and thirty-two patients with slCH, admitted to our hospital from January 2011 to September 2013 （within 24 h of onset）, were chosen in our study. Pre-stroke glycemic status, represented by hemoglobin Alc （HbAlc）, was determined the next day after admission. Patients were categorized into four groups according to HbAlc values （〈6%, 6.1%-7%, 7.1%-8% and ≥8%）. The correlations of HbAlc in the four groups with different variables （NIHSS scores, hematoma volume, modified Rankin scale [mRS] scores） were analyzed using Spearman correlation test. Patients were also categorized into two groups according to hematoma volume （≤5 mL or 〉25 mL） or mRS scores （≤2 or 〉2）. Logistic regression analyses were used to determine the relative independent risk factors for both hematoma volume and mRS scores. Results The hematoma volume, NIHSS scores, mRS scores, and number of patients with diabetes mellitus were significantly different among the four groups （P〈0.05）. Blood glucose at admission and HbAIc level were significantly correlated with hematoma volume （r=0.085, P=-0.027; r=0.164, P=-0.014）. Age and HbAlc level were significantly correlated with mRS scores （r=0.027, P=-0.019; r=0.199, P=-0.003）. Conclusion HbA1C alone could serve as a better predictor of poor outcome after slCH than glucose at admission; HbA1C is the independent risk factor ofpoor prognosis for slCH.

关 键 词：糖化血红蛋白 血糖 脑出血 

分 类 号：R743.34[医药卫生—神经病学与精神病学]