从糖尿病前期到糖尿病高危:糖调节异常与脑卒中研究最新进展

新近流行病学研究表明,由于生活方式的迅速改变,糖尿病已经成为我国的主要公共健康问题。糖尿病能够增加卒中风险2～5倍。空腹血糖受损(impaired fasting glucose,IFG)和糖耐量异常(impaired glucose tolerance,IGT)合称糖尿病前期、糖调节异常或中间型高血糖,也增加卒中风险。胰岛素抵抗,血脂代谢紊乱,凝血和纤溶异常,慢性炎症和血管内皮功能损害是可能机制。在美国糖尿病协会(American Diabetes Association)2010年指南中,"糖尿病高危"代替了"糖尿病前期"的概念,并涵盖了糖化血红蛋白(Hemoglobin A_1c)在5.7%～6.4%之间的患者。随机对照试验证实,对糖尿病高危患者进行干预能够减少糖尿病发病率。同时有研究表明治疗IGT能够减少心血管事件和高血压的发病,这需要进一步研究证实。应该对卒中患者进行筛检,发现糖尿病高危患者并进行干预。

From Pre-diabetes to Increased Risk for Diabetes-Advance in the Association between Impaired Glucose Regulation and Stroke

Prospective epidemiological study indicated recently that diabetes has become a major public health problem in China because of the rapid changes in lifestyle. The presence of diabetes increases the risk of stroke 2- to 5-fold. Not only patients with diabetes are at increased risk of stroke but also patients with impaired fasting glucose （IFG） and impaired glucose tolerance （IGT）. Underlying pathogenetic mechanisms include insulin resistance, dyslipidemia, procoagulability, impaired fibrinolysis,chronic inflammation and endothelial dysfunction. Pre-diabetes （or intermediate hyperglycaemia） has been renamed ＂Categories of increased risk for diabetes＂ in the American Diabetes Association （ADA） Guideline 2010 and Alc range of 5.7-6.4% included as a category of increased risk for future diabetes.Randomized controlled trials（RCTs） have shown that individuals at high risk for developing diabetes （those with IFG, IGT, or both） can be given interventions that significantly decrease the rate of onset of diabetes.Previous study suggested that treating IGT patients is associated with a significant reduction in the risk of cardiovascular disease and hypertension,which need further evaluation.Strategies aimed at screening and treating stroke patients with increased risk for diabetes are needed.