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目的探讨T2DM合并急性脑梗死(ACI)患者血糖水平及血糖漂移对神经功能缺损及预后的临床意义。方法纳入91例ACI患者,根据有无糖尿病史及入院24h内空腹血糖情况分为糖尿病(A)组28例、单纯应激性高血糖(B)组27例及血糖正常(C)组36例,入院早期行72h动态血糖监测(CGMS),根据《中国脑卒中神经功能缺损评分标准》(CSS),对比3组神经功能缺损程度,并与治疗2周后进行比较。结果 (1)A组女性比例、有陈旧性脑梗死及高血压史患者比例高于B、C组(P<0.05);TG、TC、HDL-C、血清同型半胱氨酸(Hcy)、尿白蛋白/肌酐比值(UACR)、胰岛素抵抗指数(HOMA-IR)、C-RP高于B、C组(P<0.01);(2)HbA1c、餐后2h平均血糖(MPBG)、血糖水平标准差(SDBG)、日内血糖波动幅度(MAGE)和日间血糖波动绝对差(MODD)高于B、C组(P<0.01)。治疗2周后,A组CSS评分高于B、C组(P<0.01);(3)MAGE与CSS评分、Hcy、HOMA-IR均相关(P<0.05);CSS评分与C-RP、Hcy、HOMA-IR相关(P<0.05);多重线性回归分析结果提示,MAGE、C-RP与CSS评分呈独立相关关系。(4)A组病灶以多发脑梗死以及椎-基底动脉系统梗死为主(P<0.01)。结论 T2DM合并ACI患者血糖波动较大,神经功能缺损更严重。血糖波动可能加重ACI进展,与预后相关。
Objective To investigate the clinical significance of blood glucose level and blood sugar drift in patients with T2DM complicated with acute cerebral infarction (ACI) on neurological deficits and prognosis. Methods A total of 91 patients with ACI were enrolled in this study. According to the presence or absence of diabetes mellitus and fasting blood glucose during admission, 28 cases were divided into diabetic group (A), 27 cases with stress hyperglycemia (B) and 36 cases with normal glucose (C) (CGMS) at 72 hours after admission. The severity of neurological deficit was compared with that of the control group according to “China Stroke Scale for Neurological Deficiency” (CSS), and compared with 2 weeks after treatment. Results (1) The proportion of women in group A was significantly higher than that in group B and C (P <0.05), TG, TC, HDL-C, serum homocysteine Urine albumin / creatinine ratio (UACR), insulin resistance index (HOMA-IR) and C-RP were higher than those in groups B and C (P <0.01); (2) HbA1c, MPBG, The standard deviation (SDBG), daily blood glucose fluctuation (MAGE) and daytime blood glucose fluctuation absolute difference (MODD) were higher than those in group B and C (P <0.01). The CSS score of group A was higher than that of group B and C after 2 weeks of treatment (P <0.01); (3) MAGE was correlated with CSS score, Hcy and HOMA-IR , And HOMA-IR (P <0.05). Multivariate linear regression analysis showed that MAGE and C-RP were independently associated with CSS scores. (4) The lesions in group A were mainly cerebral infarction and infarction of vertebrobasilar system (P <0.01). Conclusions T2DM with ACI patients with large fluctuations in blood glucose, neurological deficits more serious. Blood glucose fluctuations may aggravate the progress of ACI, and prognosis.