脑干梗死合并糖尿病的临床特点及预后分析

目的 分析糖尿病与脑干梗死发生、转归及预后的关系,探讨糖尿病对脑干梗死的影响.方法 172例急性脑干梗死病例分为糖尿病组与非糖尿病组,多元logistic回归筛选出脑干梗死伴糖尿病及影响急性脑干梗死严重程度的危险因素;比较两组不同时段美国国立卫生院卒中评分量表(NIHSS)与改良Rankin评分量表(mRS)评分、病情进展及最终结局.结果 糖尿病组收缩压、TG、LDL-C、载脂蛋白(Apo)B、γ-谷氨酰转肽酶(γ-GT)、纤维蛋白原、空腹血糖(FPG)和糖化血红蛋白(HbAlc)较非糖尿病组高,γ-GT、Apo B及FPG是糖尿病发生脑干梗死的危险因素(OR分别为1.017、4.667和3.173),HDL-C是其保护因素(OR=0.288);HbA1c是影响急性脑干梗死严重程度的危险因素(OR=1.299),Apo A为其保护因素(OR=0.212).两组患者入院时的NIHSS评分及重症监护情况差异无统计学意义;而住院进展、出院时和6个月时随访对比,差异均有统计学意义.结论 糖尿病与脑干梗死关系密切,脑干梗死伴糖尿病进展快,预后差,病死率、残疾率及再发脑梗死几率更高.

Abstract：

Objective To analyze the relationship between diabetics and the onset, clinical outcomes and prognosis of brainstem infarction, and to evaluate the impact of diabetes on brainstem infarction. Method Compare 172 cases of acute brainstem infarction in patients with or without diabetes.Analyze the associated risk factors of patients with brain-stem infarction in diabetics by multi-variate logistic regression analysis. Compare the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin scale (mRS) Score, pathogenetic condition and the outcome of the two groups in different times. Results The systolic blood pressure ( SBP ), TG, LDL-C, apolipoprotein B ( Apo B ), glutamyl transpeptidase (γ-GT), fibrinogen(Fb), fasting blood glucose (FPG) and glycosylated hemoglobin( HbA1c)in diabetic group were higher than those in non-diabetic group , which was statistically significant ( P ＜ 0. 05 ). From multi-variate logistic regression analysis, γ-GT, Apo B and FPG were the risk predictors of diabetes with brainstem infarction( OR = 1. 017, 4. 667 and 3. 173, respectively), while HDL-C was protective( OR =0. 288). HbA1c was a risk predictor of severity for acute brainstem infarction( OR = 1. 299), while Apo A was beneficial( OR =0. 212). Compared with brain-stem infarction in non-diabetic group, NIHSS score and intensive care therapy of diabetic groups on the admission had no statistically significance, while the NIHSS score on discharge and the outcome at 6 months' of follow-up were statistically significant. Conclusions Diabetes is closely associated with brainstem infarction. Brainstem infarction with diabetes cause more rapid progression, poorer prognosis, higher rates of mortality as well as disability and higher recurrence rate of cerebral infarction.

An evaluation of clinical characteristics and prognosis of brain-stem infarction in diabetics

Objective To analyze the relationship between diabetics and the onset, clinical outcomes and prognosis of brainstem infarction, and to evaluate the impact of diabetes on brainstem infarction. Method Compare 172 cases of acute brainstem infarction in patients with or without diabetes.Analyze the associated risk factors of patients with brain-stem infarction in diabetics by multi-variate logistic regression analysis. Compare the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin scale (mRS) Score, pathogenetic condition and the outcome of the two groups in different times. Results The systolic blood pressure ( SBP ), TG, LDL-C, apolipoprotein B ( Apo B ), glutamyl transpeptidase (γ-GT), fibrinogen(Fb), fasting blood glucose (FPG) and glycosylated hemoglobin( HbA1c)in diabetic group were higher than those in non-diabetic group , which was statistically significant ( P ＜ 0. 05 ). From multi-variate logistic regression analysis, γ-GT, Apo B and FPG were the risk predictors of diabetes with brainstem infarction( OR = 1. 017, 4. 667 and 3. 173, respectively), while HDL-C was protective( OR =0. 288). HbA1c was a risk predictor of severity for acute brainstem infarction( OR = 1. 299), while Apo A was beneficial( OR =0. 212). Compared with brain-stem infarction in non-diabetic group, NIHSS score and intensive care therapy of diabetic groups on the admission had no statistically significance, while the NIHSS score on discharge and the outcome at 6 months' of follow-up were statistically significant. Conclusions Diabetes is closely associated with brainstem infarction. Brainstem infarction with diabetes cause more rapid progression, poorer prognosis, higher rates of mortality as well as disability and higher recurrence rate of cerebral infarction.