急性脑梗死合并2型糖尿病患者CISS分型与血脂、红细胞分布宽度的关系

目的探讨急性脑梗死合并2型糖尿病患者的中国缺血性脑卒中分型(China Ischemic Stroke Subclassification,CISS)与血脂、红细胞分布宽度(Red Blood Cell Volume Distribution Width,RDW)的相关性。方法选择收入我院神经内科发病72小时内且合并2型糖尿病的急性脑梗死患者376例,并进行CISS分型,抽取空腹静脉血检测血总胆固醇(Total Cholesterol,TC)、甘油三酯(Triglycerides,TG)、RDW值,并分析其与CISS分型的相关性。结果 CISS分型中,大动脉粥样硬化性卒中(Large Artery Atherosclerosis,LAA)191例(50.70%),病因不确定(Undetermined Etiology,UE)103例(27.60%),其次分别为穿支动脉疾病(Penetrating Artery Disease,PAD)51例(13.50%),心源性脑卒中(Cardiogenic Stroke,CS)30例(8.00%)、其他原因所致缺血性卒中(Other Etiology,OE)1例(1.00%)。比较5种亚型TC水平,CS均低于其他4类亚型(P0.05),其余亚型两两比较无统计学意义(P0.05),存在"胆固醇悖论"现象。年龄比较,CS均高于其他4种亚型(P0.05);RDW水平比较,CS均高于其他四种类型(P0.05)。总胆固醇与CS负相关,而年龄、RDW是CS的独立危险因素(OR=1.10,2.83,均P0.01)。结论急性脑梗死合并2型糖尿病患者中以LAA及UE为主,心源性脑卒中存在"胆固醇悖论"现象,检测TC、年龄、RDW值对进行病因分型具有重要临床意义。

The Association among Blood lipid,Red Blood Cell Volume Distribution Width(RDW) and China Ischemic Stroke Subclassification (CISS) Subtypes of Ischemic Stroke Patients Combined with Type 2 Diabetes

Objective To analyze the association among blood lipid,RDW and CISS Subtypes of ischemic stroke combined with type 2 diabetes.Methods 376 patients of acute cerebral infarction with type 2 diabetes were collected as the sample of observation.CISS classification into the subcategories was determined via predefined specific clinical and imaging criteria.All of them being detected blood lipid and RDW level by extracting of fasting venous blood.To analyze correlation between blood lipid,RDW and CISS Subtypes.Results 5 major categories of the CISS classification were as follows:Large-Artery Atherosclerosis (LAA);Cardiogenic Stroke (CS);Penetrating Artery Disease (PAD);Other Etiology (OE);And Undetermined Etiology (UE).The LAA has had the highest proportion (50.70％),the UE ranked second (27.60％),followed by which is PAD (13.50％);The rest of them were respectively 8％ and 1.00％.The TC level of CS is lower than the other four subtypes (P ＜ 0.05),and the rest of them have had no difference (P ＞ 0.05).The age distribution of CS was higher than the other four subtypes (P ＜ 0.05).RDW level of CS was higher than the other four subtypes (P ＜ 0.05),and the rest of them had no difference (P ＞ 0.05);There was a negative correlation between cholesterol and CS.Age and RDW were independents risk factors of CS.Conclusions LAA and UE is the most common types in acute cerebral infarction patients with type 2 diabetes,"Cholesterol paradox" phenomenon exists in cardio embolic stroke,and testing TC,age,RDW values have important clinical significance to CISS classification.