代谢综合征与急性非栓塞性缺血性脑卒中患者预后的关系

目的 分析代谢综合征(MS)与急性非栓塞性缺血性脑卒中(ANIS)患者入院时病情严重程度的关系,探讨MS与近期预后的关系,同时分析MS各组分与病情严重程度的关系.方法 前瞻性登记2006年3月至2008年3月连续性入院的,发病在24 h内的缺血性脑卒中患者.随访3个月末时的结局.MS的诊断采用中国糖尿病协会(CDS)制定的标准.采用Logistic多因素回归模型分析MS与预后的关系.结果 纳入发病24 h内的ANIS患者共342例,年龄范围31～95岁,平均67岁±13岁.采用CDS标准诊断的ANIS患者有MS共86例,男50例(58.1%),女36例(41.9%).有MS的ANIS患者代谢异常的5个组分均高于无MS患者(均P<0.001).多因素分析显示,发病至入院时间长者和有MS的患者病情严重的风险大(RR=2.45,95% CI 1.14～5.27;RR=1.85,95%CI1.02～6.25);高血糖和甘油三酯水平低的患者病情严重的风险大(RR=3.02,95% CI 1.75～8.59;RR=0.85,95% CI 0.24～0.96);MS与3个月死亡和预后不良无关联(均P>0.05).结论 MS不是3个月预后不良的独立预测因素;MS是ANIS患者病情严重程度的独立预测因素,有MS的患者病情较重;高血糖和甘油三酯水平低的患者病情较严重.在治疗急性脑卒中时调控血糖对于改善预后有重要意义.

Association between metabolic syndrome and prognosis in acute ischemic non-embolic stroke

Objective To investigate the association between metabolic syndrome(MS)and stroke severity in at-admission patients with acute ischemic nonembolic stroke and to study the impact of MS upon prognosis:and to assess the relative influence of each of five components of MS upon the risk of stroke severity.Methods The consecutive cases of ischemic stroke were prospectively registered in neurology wards from March 2006 to March 2008.Only those patients with an onset of stroke within 24 hours were included.The outcomes were followed up at the end of 3 months after stroke onset.MS was defined according to the Chinese Diabetes Society criteria.Logistic regression was used to estimate the correlation of MS and prognosis.Results A total of 342 patients with acute isehemic non-embolic stroke within 24 hours from onset were included.Eighty six patients(50 males,36 females)had MS.The prevalence of individual components of MS was significantly higher in patients with MS as compared with those without.The delay from onset of symptoms to hospital admission and MS were associated with severe stroke in multiple logistic regression model(RR=2.45,95% CI,1.14-5.27;RR=1.85,95% CI,1.06-6.25 respectively).Analysis of the association between the development risk of sever stroke showed that hyperglycemia and low triglyceride level had associations with severe stroke(RR=3.02,95% CI,1.75-8.59;RR=0.85,95%CI,0.24-0.96 respectively).MS was not an independent predictor for case fatality and poor outcome 3 months after stroke onset(all P＞0.05).Conclusion Not an independent predictor for mortality and poor outcome at 3 menths after stroke onset.MS is an independent predictor for the severity of stroke and there is a hisher development risk of severe stroke.Among MS components,hyperglycemia and low triglyceride level are correlated with the development risk of severe stroke.This finding has important clinical implication and confirms the importance of glycemic control during acute phase of ischemic stroke.