应激性血糖升高比值对老年轻型急性缺血性脑卒中复发影响的巢式病例对照研究  

Nested Case-control Study on the Impact of Stress Hyperglycemia Ratio on the Recurrence of Mild Acute Ischemic Stroke in the Elderly

作　　者：高开茜 杨玉 胡艳芳 董发发 GAO Kaiqian;YANG Yu;HU Yanfang;DONG Fafa(Department of Internal Medicine,Shijiazhuang Fifth Hospital,Shijiazhuang 050021,China;Department of Infection,Shijiazhuang Fifth Hospital,Shijiazhuang 050021,China)

机构地区：[1]河北省石家庄市第五医院内科,050021 [2]河北省石家庄市第五医院感染科,050021

出　　处：《中国全科医学》2024年第14期1692-1698,共7页Chinese General Practice

基　　金：石家庄市科学技术研究与发展计划项目(231200393)。

摘　　要：背景在我国老龄化的背景下,急性缺血性脑卒中(AIS)发病率和复发率逐年上升,且死亡率和致残率较高。近年来应激性血糖升高比值(SHR)在心脑血管性疾病中的应用越来越多,但其在轻型AIS复发中的研究目前尚少。目的探究SHR与老年轻型AIS患者1年内复发的关联性,为AIS复发的预防提供更多的理论依据。方法选择2018年5月—2022年1月在石家庄市第五医院初次诊断为轻型AIS患者为研究对象。以确诊轻型AIS为起点,确诊后1年为终点,采用巢式病例对照研究方式,将确诊1年内复发的患者纳入复发组,并以“诊断时间、年龄、性别、梗死部位及是否患有糖尿病”为条件,按1∶3的比例匹配非复发组。共70例患者纳入复发组,匹配210例患者纳入非复发组。通过医院信息系统(HIS系统),采集患者性别、年龄、高血压史、心房颤动史、BMI、基线美国国立卫生研究院神经功能缺损评分(NIHSS评分)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA_(1c))、入院随机血糖等,并计算SHR。采用多因素条件Logistic回归分析探究SHR与老年轻型AIS患者1年内复发的关联性。结果280例患者平均年龄(71.9±6.4)岁;男176例(62.9%),女104例(37.1%);糖尿病史患者88例(31.4%)。根据数据的中位数,以应激性血糖≥10 mmol/L为高,<10 mmol/L为低;SHR>1.04为高,≤1.04为低。多因素条件Logistic回归分析结果显示,应激性血糖(OR=2.983,95%CI=1.488~5.977)、SHR(OR=3.056,95%CI=1.579~5.914)是老年轻型AIS患者1年内复发的影响因素(P<0.05)。88例有糖尿病史的轻型AIS患者中,1年内复发22例,非复发66例;192例无糖尿病史的轻型AIS患者中,1年内复发48例,非复发144例。分层分析的多因素条件Logistic回归分析结果显示,SHR仍是有糖尿病史(OR=3.757,95%CI=1.019~13.845)和无糖尿病史(OR=3.129,95%CI=1.162~8.427)老年轻型AIS患者1年内复发的影响因素(P<0.05)。以SHR分别为1.00、1.40、1.80为间�Background In the context of aging in our country,the incidence and recurrence rates of acute ischemic stroke(AIS)are increasing year by year,and the mortality and disability rates are high.In recent years,the application of stress hyperglycemia ratio(SHR)in cardiovascular and cerebrovascular diseases has become more and more common,but its research in the recurrence of mild AIS is currently limited.Objective To explore the correlation between SHR and the recurrence of mild AIS in elderly patients within one year,and to provide a more theoretical basis for the prevention of AIS recurrence.Methods The study selected patients who were first diagnosed with mild AIS at the Shijiazhuang Fifth Hospital from May 2018 to January 2022.The study started with the diagnosis of mild AIS and ended one year after the diagnosis.A nested case-control study was conducted,and patients who were confirmed to have a recurrence within one year were included in the recurrence group.The non-recurrence group was matched at a ratio of 1∶3 based on'diagnosis time,age,gender,infarction location,and whether they have diabetes'.A total of 70 patients were included in the recurrence group,and 210 patients were matched in the nonrecurrence group.Through the Hospital Information System(HIS),patients gender,age,history of hypertension,history of atrial fibrillation,BMI,baseline NIHSS score,LDL-C,HbA_(1c),random blood glucose on admission,etc.were collected,and the SHR was calculated.Multivariate conditional Logistic regression analysis was used to explore the correlation between SHR and the 1-year recurrence of mild AIS in elderly patients.This study is likely investigating the influence of the SHR on the recurrence of AIS within one year in elderly patients.Results The average age of the 280 patients was(71.9±6.4)years;176 were male(62.9%),and 104 were female(37.1%);88 patients(31.4%)had a history of diabetes.According to the median of the data,stress hyperglycemia≥10 mmol/L was considered high,<10 mmol/L was considered low;SHR>1.04 was cons

关 键 词：卒中 复发 应激性血糖升高比值 老年人 预后 条件LOGISTIC回归分析 

分 类 号：R743[医药卫生—神经病学与精神病学]