老年2型糖尿病合并急性脑梗死患者的血糖水平对预后的影响

目的探讨内蒙古满洲里地区老年2型糖尿病合并急性脑梗死时血糖水平与病情严重程度及预后的关系。方法对2010年至2011年内蒙古满洲里市南区医院住院的老年2型糖尿病合并急性脑梗死患者126例临床资料进行回顾性分析，按脑梗死严重程度分轻、中、重度，同时按入院时的空腹血糖水平，将全部患者分为A（空腹血糖7．0～11．1mmol／L）、B（空腹血糖11．1～16．7mmol／L）、C（空腹血糖≥16．7mmol／L）三组，观察高血糖与病情严重程度、脑CT扫描梗死灶大小和急性期预后的关系。结果A、B两组患者之间的梗死灶大小、不同神经功能缺损程度所占人数及不同预后所占人数比较差异均无统计学意义（P〉0．05）；而空腹血糖≥16．7mmol／L的患者，梗死灶大小、不同神经功能缺损程度所占人数及不同预后所占人数与A、B两组比较差异均有统计学意义（P〈0．05，P〈0．01）。结论糖尿病并发脑卒中者临床症状的轻重及病情转归情况与患者血糖水平的高低密切相关，血糖≥16．7mmol／L是糖尿病合并急性脑梗死急性期预后不良的重要指标。

Influence of hyperglycemia on short term prognosis in elderly diabetic patients with acute cerebral infarction

Objective To evaluate the influence of hyperglycemia in elderly diabetic patients with acute cerebral infarction. Methods We retrospectively analyzed 126 acute cerebral infarction cases among 232 elderly diabetic patients who had been treated in Manzhouli Southern District Hospital of Inner Mongolia from Jan, 2010 to Dec, 2011. All the patients were divided into three groups by the level of fasting plasma glucose （FPG） acquired when they were admitted to hospital ： group A （FPG 7.0-11.1mmol/L）, group B（FPG 11.1-16.7mmol/L）, and group C （FPG ≥16.7mmol/L） . Meanwhile, the severity of cerebral infarction was categorized as mild, moderate and severe. The relationship among level of hyperglycemia, severity of disease, the size of brain CT scan and acute prognosis were evaluated. Results No statistically significant difference was found in size of infarction, the numbers of patients with different degree of neural function defect, and the numbers of patients with diverse prognosis （P 〉 0.05）. Compared with group A and group B, the infarct size was statistically significantly larger in group C （P 〈 0.05）, patients in which had blood glucose over 16.7mmol/L. Compared with group A, less patients in group C had mild and moderate neurological impairment, and more patient had severe impairment（ P 〈 0.01）. Less patients in group C had good prognosis （ roughly cure or apparently improved, P 〈 0.01）, and more patients had bad prognosis（ death, getting worse or no change, P 〈 0.01） than patients in group A. Conclusion In patients with diabetes and cerebral stroke, the severity of ctinical symptoms and prognosis are closely related to the level of blood glucose. Level of blood glucose over 16.7mmol/L was an important indicator of bad prognosis in acute period.