糖代谢异常对慢性缺血性脑白质疏松的影响

目的：探究糖代谢异常对慢性缺血性脑白质疏松（LA）的影响。方法回顾性分析2013年6月～12月中国医科大学附属第四医院神经内科收治的258例缺血性脑血管疾病患者的临床资料。根据病史及化验结果将糖代谢情况分为正常糖代谢、2型糖尿病以及前驱期糖尿病，依据头MRI结果对LA严重程度进行分级，分析比较不同糖代谢情况以及不同血糖化验指标（包括FPG、2hPG及HbA1c）对慢性缺血性脑白质疏松及其严重程度的影响。结果单因素分析显示，慢性缺血性脑白质疏松的相关危险因素有年龄、高血压病史、糖尿病病史、糖代谢异常、甘油三酯、2hPG（OR＞1，P＜0.05）。Logistic回归分析显示脑白质疏松与年龄、高血压病史、2hPG相关（P＜0.05）。Spearman秩相关检验显示LA严重程度分级与年龄大小、高血压病史时长、2hPG水平呈正相关，与HDL、apoA、腔梗病史呈负相关（P＜0.05，r=0.402、0.227、0.135、-0.154、-0.147、-0.312）。结论年龄、高血压病史、糖尿病病史、糖代谢异常、2hPG、甘油三酯是脑白质疏松的危险因素；年龄越大、高血压病史时间越长、2hPG越高、HDL及apoA越低，脑白质疏松越严重；而FPG、HbA1c、前驱期糖尿病、糖尿病及其时长与脑白质疏松的严重程度无相关性。

Impacts of Abnormal Glucose Metabolism on Chronic Ischemic Leukoaraiosis

Objective To explore the impacts of abnormal glucose metabolism on chronic ischemic leukoaraiosis （LA）.Methods The clinical data of 258 patients with ischemic cerebrovascular disease were analyzed who were cured in the Fourth Affi liated Hospital of China Medical University from Jun to December in 2013. According to the medical history and laboratory reports, these patients were divided into normal glucose metabolism group, type 2 diabetes group and pre-diabetes group. Based on the results of head MRI, the severity of leukoaraiosis was graded. Then we compared and analyzed the impacts of different glucose metabolism and different glycemic indexes on chronic ischemic leukoaraiosis and its severity; the glycemic indexes including FPG, 2hPG and HbA1c.Results Univariate analysis showed that age, diabetes history, abnormal glucose metabolism, hypertension history, triglycerides and 2hPG were the risk factors associated with chronic ischemic leukoaraiosis （OR〉1,P〈0.05）. Logistic regression analysis showed that leukoaraiosis was correlated with age, hypertension history, 2hPG levels （P〈0.05）. Spearman rank correlation analysis showed that the severity of leukoaraiosis was positively correlated with age, the length of hypertension history and 2hPG levels, and was negatively correlated with HDL levels, apoA levels and lacunar infarct history （P〈0.05,r=0.402, 0.227, 0.135, -0.154, -0.147, -0.312）. Conclusion The risk factors of chronic ischemic leukoaraiosis are as follows： age, hypertension history, diabetes history, abnormal glucose metabolism, triglycerides and 2hPG. Leukoaraiosis is positively rank correlated with age, diabetes history, hypertension history and the levels of triglycerides and 2hPG, while is negatively rank correlated with the levels of HDL and apoA. The severity of leukoaraiosis has no correlation with FPG, HbA1c, pre-diabetes, diabetes history and its length.