高龄脑卒中患者糖代谢异常对不良预后的影响

目的探讨高龄脑卒中患者糖尿病和糖尿病前期现患率及其对预后的影响。方法选择高龄初发脑卒中患者220例。根据诊断分为糖尿病组111例,糖尿病前期组62例,糖代谢正常组47例。住院期间生存依赖结局依据出院时改良Rankin评分(mRS),较好为mRS 0¹分75例,较差为mRS 21分75例,较差为mRS 2⁶分145例。比较各组糖代谢异常与脑卒中类型及缺血性脑卒中亚型的关系。结果与糖代谢正常组比较,糖尿病组和糖尿病前期组美国国立卫生研究院脑卒中量表评分和空腹血糖明显增高,差异有统计学意义(P<0.05)。糖尿病组和糖尿病前期组大动脉粥样硬化性血栓型脑梗死率均较小动脉型梗死高,但差异无统计学意义(P>0.05)。多因素校正后,糖尿病组及糖尿病前期组均较糖代谢正常组,更易罹患不良生存依赖结局。糖尿病组OR=8.19,95%CI:2.916分145例。比较各组糖代谢异常与脑卒中类型及缺血性脑卒中亚型的关系。结果与糖代谢正常组比较,糖尿病组和糖尿病前期组美国国立卫生研究院脑卒中量表评分和空腹血糖明显增高,差异有统计学意义(P<0.05)。糖尿病组和糖尿病前期组大动脉粥样硬化性血栓型脑梗死率均较小动脉型梗死高,但差异无统计学意义(P>0.05)。多因素校正后,糖尿病组及糖尿病前期组均较糖代谢正常组,更易罹患不良生存依赖结局。糖尿病组OR=8.19,95%CI:2.91¹0.80,糖尿病前期组OR=4.52,95%CI:1.0110.80,糖尿病前期组OR=4.52,95%CI:1.01⁷.23。结论高龄急性初发脑卒中患者中,有半数以上的患者符合糖代谢异常的诊断;糖尿病及糖尿病前期均是脑卒中后住院期间不良预后的独立风险预测因素;住院期间行口服葡萄糖耐量试验对判断脑卒中后不良预后具有重要价值。

Effect of glycometabolism disorder on poor outcomes in advance-aged ischemic stroke patients

Objective To study the prevalence of diabetes and prediabetes in acute stroke patients. Methods Two hundred and twenty advance-aged(≥80)first-ever stroke patients were divided into diabetes group(n=111),prediabetes group(n=62)and normal glycometabolism group(n= 47)according to their OGTT results.Their outcomes at discharge were evaluated according to the modified Rankin scale(mRS).The outcome was favorable in 75patients with a mRS score of 0-1and poor in 145patients with a mRS score of 2-6.The relationship of abnormal glycometabolism with acute stroke and its subtypes was assessed among the 3groups.Results The fasting plasma glucose level and NIHSS in diabetes and pre-diabetes groups were statistically significantly higher than in normo-glycemia group(P<0.05).No significant difference was found in the incidence of large artery and small vessels stroke although the former was higher than the latter in diabetes group and prediabetes group(P>0.05).The outcome was poorer in diabetes group(OR=8.19,95%CI:2.91-10.80)and prediabetes group(OR=4.52,95%CI:1.01-7.23)than in normal glycometabolism group.Conclusion Of the first-ever acute stroke patients with their age≥80years,over 50%can be diagnosed with abnormal glycometabolism.Diabetes and prediabetes are the independent risk factors for the short-term poor outcomes in acute stroke patients. OGTT plays an important role in predicting the poor outcome in acute stroke patients.