血糖变异与急性缺血性卒中患者预后的相关性

目的 研究血糖变异与急性缺血性卒中患者预后的相关性，为改善患者预后提供临床依据。 方法 连续性入住我院的急性缺血性卒中患者，入院后进行TOAST 分型；根据患者血糖水平的标准差，分为血糖变异组（血糖水平的标准差≥1.4 mmol/L）和对照组（血糖水平的标准差＜1.4 mmol/L），血糖变异组83例，对照组92例，其中男性78例（44.6%），平均年龄为（72.2±13.2）岁。患者入院时采用美国国立卫生研究院卒中量表（NIHSS）评估神经功能缺损程度，根据发病后90天改良Rankin量表(mRS)评分判定预后情况。比较血糖变异组和对照组患者基线资料的差异，建立Logistic回归模型分析血清血糖变异与急性缺血性卒中患者90天预后的相关性。结果 83例（47.4%）的患者存在血糖变异。血糖变异组和对照组患者的年龄（74.7±12.7岁 vs 70.0±13.3岁，P=0.019）、糖尿病史（28例 vs 14例，P=0.007）、既往卒中史（16例 vs 6例，P=0.011）差异有统计学意义。血糖变异组和对照组的TOAST亚型构成上差异有统计学意义（P=0.001）。logistic回归模型分析结果提示，血糖变异（OR=3.235，95%CI=1.185 8.130，P=0.022）、高龄（OR=1.114，95%CI=1.061 1.169，P<0.001）和入院时NIHSS评分高（OR=2.214，95%CI=1.713 2.863，P<0.001）是缺血性卒中患者90天预后的独立危险因素。结论 血糖变异、高龄和入院高的NIHSS评分与缺血性卒中患者90天预后独立相关。

Blood glucose variability and prognosis in patients with acute ischemic stroke

Objective To study the relationship between blood glucose variability and prognosis in patients with acute ischemic stroke for the clinical basis in relieving the prognosis in the patients. Methods Acute ischemic stroke patients in our hospital were enrolled. All patients were classified by TOAST subtypes. According to the standard deviation of the blood glucose level， the patients were divided into the blood glucose variability group (standard deviation of blood glucose level≥1.4 mmol/L) and control group(standard deviation of blood glucose level ＜1.4 mmol/L). In addition， neurological function deicits scale was evaluated by the National Institutes of Health Stroke Scale(NIHSS) and the conditions of prognosis after the 90 days was evaluated by the modified Rankin Scale. The difference in blood glucose variability group and control group was compared. Then， the relationship between blood glucose variability and prognosis was analyzed with logistic regressive model. Results Eighty three patients (47.4%) had blood glucose variability. The average age (74.7±12.7 vs 70.0±13.3 years，P=0.019)， diabetes history(28 cases vs 14 cases，P=0.007)， and stroke history (16 cases vs 6 cases，P<0.01) were significantly different between blood glucose variability group and control group. Logistic regressive model showed that the blood glucose variability (OR=3.235，95%CI=1.185 8.130，P=0.022)， advanced age(OR=1.114，95%CI=1.061 1.169，P<0.001) and higher admission NIHSS scores(OR=2.214， 95%CI=1.713 2.863，P<0.001) were independent risk factors of acute ischemic stroke. Conclusion Blood glucose variability， advanced age and higher admission NIHSS scores were related to 90 days’ prognosis of acute ischemic stroke.