急性脑血管病患者早期空腹血糖水平与预后关系的临床研究

目的  探讨急性脑血管病患者早期空腹血糖水平与预后关系。 方法  采用卒中登记方法，连续纳入急性脑血管病患者699例，收集空腹血糖、入院采用美国国立卫生研究院卒中量表（NIHSS）评分、既往病史等临床资料，随访六个月死亡率和改良Rankin量表（MRS）评分。采用Logistic多元回归分析卒中预后危险因素。 结果  有糖尿病史者早期空腹血糖更高，出现早期空腹血糖升高的患者比例更高。出血性卒中血糖升高患者的比例显著高于缺血性卒中。轻度卒中患者平均血糖水平较中重度卒中患者要低，而中重度卒中患者出现血糖升高的比例与轻度卒中相比无显著差异。血糖升高组和正常组6个月死亡率未见显著差异，但血糖升高组六个月MRS更差。多因素分析发现入院NIHSS>5分（OR 7.004，95% C I：4.490~10.925，P<0.001）、既往有脑梗死病史（OR 2.769，95% C I：1.237~6.197，P<0.05）、年龄>70岁（OR 2.549，95% C I：1.633~3.980，P<0.001）、血糖>7.0 mmol/L（OR1.808，95% C I：1.088~3.005，P<0.05）有统计学差异。 结论  急性脑血管病患者早期空腹血糖升高是6个月预后的独立影响因素。

Fasting blood glucose level and prognosis of patients with acute stroke

Objective To explore the relationship between fasting blood glucose level and prognosis for patients with acute stroke.Methods 699 consecutive patients with acute stroke were registered and included in the study.All patients underwent fasting blood glucose determination and quantification on the stroke severity based on National Institute of Health Stroke Scale（NIHSS） upon admission.A six-month prospective follow-up was performed in the eligible patients for the mortality and Modified Rankin Scale（MRS） was used to measure the degree of disability or dependence in the daily activities in the survivals.Multivariate logistic regression analysis was performed to determine the risk factors affecting prognosis of patients after stroke.Results The patients with history of diabetes had higher fasting blood glucose level,and accounted for a higher percentage in those with elevated level of fasting blood glucose.Although hyperglycemia was more frequent in patients with hemorrhagic stroke than those with ischemic stroke,yet the level was lower in patients with mild stroke than those with moderate stroke.Nevertheless,tendency of hyperglycemia remained no significant difference for those two groups of patients.The mortality at six-month was not significant between the patients with elevated blood glucose level and those with normal level,whereas patients with hyperglycemia were rated higher by the MRS.Multivariate logistic analysis showed that NIHSS5（OR=7.004,95%CI：4.490-10.925,P0.001）,attack history of cerebral infarction（OR=2.769,95%CI：1.237-6.197,P0.05）,age70 years（OR=2.549,95%CI：1.633-3.980,P0.001） and hyperglycemia（OR=1.808,95%CI：1.088-3.005,P0.05） were independent prognostic factors for poor prognosis.Conclusion Hyperglycemia was the independent prognostic factors for poor outcome in patients with acute stroke after six months of onset.