急性缺血性脑卒中患者血糖水平与病情预后关系的临床研究

目的探讨急性缺血性脑卒中患者血糖水平与病情预后的关系。方法对我院2004年1月～2009年3月经CT或MRI证实的224例急性缺血性脑卒中按血糖和糖化血红蛋白水平分为血糖正常组（102例）、应激性高血糖组（65例）和糖尿病组（57例），并对各组患者患病情况和治疗结果进行分析。结果应激性高血糖组与糖尿病组的后循环脑梗死构成比明显高于血糖正常组（P〈0．01）。糖尿病组及应激性高血糖组大面积脑梗死构成比明显高于血糖正常组（P〈0．01，P〈0．05），应激性高血糖组好转率（23．08％，15／65）明显低于血糖正常组（56．86％，58／102）（P〈0．01）和糖尿病组（49．12％，28／57）（P〈0．05）。应激性高血糖组急性缺血性脑卒中病死率（16．92％）明显高于糖尿病组（12．28％）及血糖正常组（3．73％），差异有统计学意义（P〈0．05）。结论血糖水平可作为预测急性缺血性脑卒中病情及预后的重要参考指标之一，早期有效监测并控制血糖可降低急性缺血性脑卒中发生后的脑损害。

Correlation between Blood Glucose Level and Pathogenetic Condition and Prognosis of Patients with Acute Cerebral Arterial Thrombosis

Objective To study the relationship between blood glucose level and pathogentic condition and prognosis of patients with acute cerebral arterial thrombosis. Methods CT or MRI confirmed 224 patients with ACAT （January 2004 to March 2009） were divided according to blood glucose levels and glycated hemoglobin levels into normal group（n = 102）, post stroke stress hyperglycemia （n = 65） and diabetic group （n = 57）. The pathogenetic conditions and treatment outcomes were analyzed. Results The ratio of posterior circulation infarction in the diabetic group and 6 tress-induced hy- perglycemia group was significantly higher than that of the normal blood glucose group （ P 〈0.01 ）. The constituent ratio of infarction area in the diabetic group and stress-induced hyperglycemia group was significantly higher than that of the normal blood glucose group （P 〈 0.01, P 〈 0.05）, the improvement rate of the stress-induced hyperglycemia group was 23.08% （15/65）, significantly lower than that of the normal blood glucose group （56.86% ,58/102）（P 〈0, 01 ） and diabetes group （49.12%, 28/57）（ P 〈0.05）. The fatality rate of the stress-induced hyperglycemia group （16.92%） was significantly higher than that of the diabetic group （12.28%） and blood glucose in normal group （3.73%） , with statistically significant difference （P 〈0.05）. Conclusion The blood glucose levels can be used as an important reference to predict pathogenetic conditions and prognosis. Early and effective monitoring and control of blood sugar can reduce brain damage after acute ischemic stroke.