急性脑梗死合并2型糖尿病与血糖漂移及同型半胱氨酸水平的相关性研究

目的探讨急性脑梗死合并2型糖尿病（T2DM）患者入院早期血糖漂移及同型半胱氨酸水平对预后的影响。方法以62例急性脑梗死为研究对象，根据有无T2DM分为合并T2DM组（A组，n=38）和非合并T2DM组（B组，n=24），对两组进行72h动态血糖监测，比较相关指标。所有患者发病24h内确诊，遵循缺血性脑卒中治疗指南给予相应规范化治疗，比较两组治疗前后中国脑卒中患者临床神经功能缺损评分标准（CSS）评分。结果①两组糖化血红蛋白（HbA1C）、日内平均血糖波动幅度（MAGE）、血糖标准差（SDBG）、日间血糖波动幅度（MODD）、胰岛素抵抗指数（HOMA—IR）、血清同型半胱氨酸（Hcy）比较，差异均有统计学意义（P〈0．05，P〈0．01）。②MAGE与CSS评分、Hcy、HOMA-IR、病程显著相关（r=0．531、r=0．518、r=0．360、r=-0．510，P〈0．05）；CSS评分与CRP、Hcy、HOMA-IR、部分凝血酶原活动时间（APTT）显著相关（r=0．481、r=0．472、r=0．352、r=0．346，P〈0．05）。A组治疗前后CSS评分均高于B组（P〈0．01）。③以CCS评分为因变量，其他因素为自变量行多重线性回归，MAGE及血清Hcy进入最终的回归方程。结论急性脑梗死合并糖尿病患者血糖波动更明显，预后较差。减少血糖波动，降低血清Hcy水平，可延缓急性脑梗死合并糖尿病患者的病程进展，改善预后。

Relationship between Acute Cerebral Infarction Complicated with Type 2 Diabetes MeUitus with Glucose Excur- sion and Homocysteine Level

Objective To investigate the effect of glucose excursion and homocysteine level on the prognosis of patients with acute cerebral infarction complicated with type 2 diabetes mellitus （T2DM） upon early admission. Methods Sixty-two patients with acute cerebral infarction were included in the study, and divided into complications of diabetes group （group A, n = 38 ） and only diabetes group （group B, n = 24） according to whether there was complicated with di- abetes or not. The 72 h continuous glucose monitoring （CGM） was performed in the two groups, and compared with cor- related indexes. All the patients were diagnosed within 24 hours and given corresponding standardized treatment of cere- bral ischemic stroke, and then scores of China Stoke Scales （CSS） were compared in the two groups before and after treatment. Results ①he differences in levels of glycated hemoglobin （HbAlc） , the mean amplitude of glycemic ex- cursions （MAGE） , standard deviation （SDBG） , absolute means of daily difference （ MODD ） , homeostasis model of as- sessment-insulin resistance （HOMA-IR） and homocysteine （HCY） in the two groups were statistically significant （P 〈 0. 05, P 〈 0.01 ）. ②MAGE was significantly correlated with CSS scores, HCY level, HOMA-IR indexes and the course of disease （ r = 0.531, r = 0.518, r = 0. 360, r = - 0.510, P 〈 0.05 ） , and CCS scores were significantly correlated with C-reactive protein （CRP）, HCY, HOMA-IR, activated partial thromboplastin time （APTT） （r = 0. 481, r = 0. 472, r = 0. 352, r = 0. 346, P 〈 0. 05）. The CCS scores in group A were significantly higher than those in group B before and after treatment （P 〈 0.01 ）. ③Multiple linear regression, which made the CSS as the dependent variables, and other relative factors as the independent variables, showed that MAGE and HCY went into regression equation. Conclusion The blood glucose ftuctuation in patients with acute cerebral infarction complicated with diabetes mellitus is more obvious with worse prognosis. The progression can be delayed, and prognosis can be improved in patients with acute cerebral infarctioncomplicated with diabetes mellitus by reducing glucose excursion and homocysteine level.