老年急性岛叶梗死与应激性高血糖发生风险的相关性  

Relationship between acute insular infarction and stress hyperglycemia in the elderly

作　　者：蔡颖源[1] 陆小伟[1] CAI Ying-yuan;LU Xiao-wei(Department of Geriatrics, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China)

机构地区：[1]南京医科大学第一附属医院老年医学科,江苏省南京市210029

出　　处：《实用老年医学》2021年第11期1126-1130,共5页Practical Geriatrics

基　　金：国家自然科学基金资助项目(81771286)。

摘　　要：目的探讨老年人急性岛叶梗死与应激性高血糖(stress hyperglycemia,SH)发生风险的相关性。方法回顾性连续纳入2017~2018年间就诊于江苏省人民医院急诊的年龄≥60岁的急性前循环缺血性卒中病人75例,根据头颅MRI将病人分成未累及岛叶组和累及岛叶组。收集2组病人基本临床资料、NIHSS评分、血压、血清葡萄糖、Hb、肌酐、HbA1c水平。采用应激性高血糖比率(stress hyperglycemia ratio,SHR)评估SH强度。采用四分位数法将SHR分类,有序回归分析相关因素对SHR增高的风险预测。将SHR≥1.14定义为SH,行二元Logistic回归分析相关因素对卒中后SH的风险预测。结果累及岛叶组和未累及岛叶组有糖尿病史(P=0.027)、SH的比例(P=0.041)差异均有统计学意义。SHR随NIHSS评分升高呈上升趋势(r2=0.121)。有序回归分析结果显示,NIHSS评分每升高1分,SHR增高风险增加1.214倍(P=0.017);岛叶受累则SHR增高风险增加2.641倍(P=0.036)。Logistic回归分析显示,累及岛叶可使发生SH的风险增加2.917倍(P=0.041)。结论岛叶受累是老年急性前循环梗死病人SH发生的独立危险因素。Objective To investigate the relationship between acute insular infarction and stress hyperglycemia(SH)in the elderly.Methods A total of 75 patients(≥60 years)with acute anterior circulation ischemic stroke(ACI)in the Emergency Department of Jiangsu Province Hospital from January 2017 to December 2018 were enrolled.According to MRI,the patients were divided into insular cortex involved group and non-involved group.The clinical features were collected,as well as National Institute of Health Stroke Scale(NIHSS),blood pressure,serum glucose,hemoglobin,creatinine and glycosylated hemoglobin(HbA1c).Stress hyperglycemia ratio(SHR)was used to assess the intensity of SH.SHR was classified by quartile category.Ordinal regression analysis was used to explore the relationships between the risk factors and the increase of SHR category.SHR≥1.14 was defined as SH,and then binary Logistic regression analysis was performed to predict the risk of post-stroke SH.Results There were significant differences in diabetes mellitus history(P=0.027)and SH(P=0.041)between the insular cortex involved group and non-involved group.With the increase of NIHSS score,SHR showed an upward trend(r2=0.121).The risk of the increase of SHR category increased to 1.214-fold(P=0.017)with the increase of 1 point of NIHSS score,and to 2.641-fold(P=0.036)with insular involvement.The risk of SH increased to 2.917-fold(P=0.041)with insular involvement.Conclusions Insular involvement is an independent risk factor for SH in the elderly patients with ACI.

关 键 词：老年人 急性前循环脑梗死 应激性高血糖 岛叶梗死 

分 类 号：R743.33[医药卫生—神经病学与精神病学]