急性缺血性卒中患者糖代谢异常的临床研究

发布时间：2018-06-25 21:37

本文选题：急性缺血性卒中 + 口服葡萄糖耐量试验　；参考：《河南科技大学》2013年硕士论文

【摘要】：目的：第一：调查急性缺血性卒中(acute ischemic stroke，AIS)患者糖代谢异常（abnormal glucose regulation，AGR）的患病率；第二：研究伴糖调节受损（impaired glucose regulation,IGR）的AIS患者的人口学特征、临床特征；第三：探讨伴有AGR的AIS患者的病因。方法：采用横断面研究设计，连续入选2011年10月～2012年10月在河南科技大学第一附属医院住院的急性缺血性卒中患者为研究对象，并经头颅核磁共振（magnetic resonance imaging，MRI）证实。记录患者的人口学特征（年龄、性别、身高、体重、血压、腰围、臀围），危险因素（糖尿病(diabetesmellitus，DM)史、高血压史、心脏病史，吸烟、饮酒史，记录各项生化指标（空腹血糖(fasting plasma glucose，FPG),糖化血红蛋白，甘油三脂，总胆固醇，低密度脂蛋白,同型半胱氨酸）。对无糖尿病史的患者于发病后（7±3）天行口服OGTT(oral glucose tolerance test)检测空腹和餐后2h血糖，根据OGTT结果将患者分为三组：糖耐量正常组（normal glucose tolerance，NGT）、IGR组(IFG、IGT、IFG+IGT)、DM组。并根据中国缺血性卒中亚型（Chinese Ischemic StrokeSubclassification，CISS）标准对伴AGR的AIS患者进行病因分型。结果： 1、连续收集AIS患者412例，有效纳入372例患者。372例AIS患者中，发现AGR291（78.2%）例，其中DM166（44.6%）例，IGR125(33.6%)例，其中I-IGT96（25.8%）例，I-IFG6（1.6%）例，复合性糖耐量受损（IGT+IFG）23（6.2%）例，NGT81(21.8%)例。入院前已被诊断DM的患者94(25.3%)例，无DM史的患者根据FPG新诊断DM46（12.4%）例，IGR29(7.80%)例，203例行OGTT检查，又发现DM26(6.99%)例，IGR96(25.8%)例,NGT81(21.8%)例。 2、与OGTT比较,HbA1c筛查IGR(FPG或IGT)的切点5.45%（灵敏度为84.8%，特异度为75.0%）；HbA1c诊断DM的切点6.05%（灵敏度为79.5%，特异度为86.4%）。 3、三组间比较，体质指数、腰围、臀围、腰围/臀围比值，同型半胱氨酸，差异无统计学意义（P＞0.05）。吸烟，饮酒，卒中史、心脏病史患病率无统计学意义(p＞0.05)。 DM组与NGT组比较，DM组吸烟史（X2=8.994，P=0.003）、饮酒史（X2=5.594，P=0.014）患病率均低于NGT组，而男性（X2=6.070，P=0.009）、高血压史（X2=7.004，P=0.006）患病率高于NGT组，差异有统计学意义；三组间两两比较，DM组高脂血症患病率分别高于IGR组（p＜0.05）和NGT组（p＜0.05），IGR组高脂血症患病率高于NGT组（p＜0.05）。DM组糖化血红蛋白水平分别高于IGR组（p＜0.01）和NGT组（p＜0.01），IGR组糖化血红蛋白高于NGT组（p＜0.01）。 4、老年患者(≥60岁)与非老年患者(60岁)比较，老年患者(≥60岁)糖代谢异常患病率高于非老年患者(60岁)（X2=6.615,P=0.0370.05）。 5、AIS患者中，大动脉粥样硬化性脑梗死262（70.4%）例，心源性脑梗死32（8.6%）例，穿支动脉疾病62（16.7%）例，其他原因9（2.4%）例，病因不明确7（1.9%）例。其中IGR患者125例，大动脉粥样硬化90（72.2%）例，心源性脑梗死13（10.4%）例，穿支动脉疾病18（14.4%）例，其他原因3（2.4%）例，病因不明确1（0.8%）例。DM患者166例，大动脉粥样硬化118（71.1%）例，心源性脑梗死14（8.4%）例，穿支动脉疾病27（16.3%）例，其他原因3（1.8%）例，病因不明确4（2.4%）例。IGR组与DM比较，病因学分型无统计学意义（X2=1.663,P=0.797）。结论： 1、AIS患者AGR患病率较高。OGTT检测比单纯检测空腹血糖可发现更多伴糖代谢异常的急性缺血性卒中患者。 2、年龄≥60岁，伴高脂血症，HbA1c≥5.45%的急性缺血性卒中患者建议行OGTT检测以发现AIS中伴糖调节受损的患者。 3、C1SS分型中大动脉粥样硬化是伴糖代谢异常的急性缺血性卒中患者最常见病因类型。
[Abstract]:Objective: First: To investigate the prevalence of abnormal glucose metabolism (abnormal glucose regulation, AGR) in patients with acute ischemic stroke (acute ischemic stroke, AIS); second: To study the demographic characteristics and clinical characteristics of patients with impaired glucose regulation (impaired glucose regulation, IGR); and third.
Methods: using cross-sectional study and design, the patients with acute ischemic stroke hospitalized in the First Affiliated Hospital of Henan University of Science and Technology from October 2011 to October 2012 were selected and confirmed by magnetic resonance imaging (MRI). The demographic characteristics of patients (age, sex, height, weight, blood pressure, waist) were recorded. Peri, hip circumference, risk factors (diabetesmellitus, DM) history, hypertension history, heart disease history, smoking, drinking history, record all biochemical indexes (fasting blood glucose (fasting plasma glucose, FPG), glycated hemoglobin, glycerol three fat, total cholesterol, low density lipoprotein, homocysteine). (7 + 3) for patients without diabetes. OGTT (oral glucose tolerance test) was used to detect the fasting and postprandial 2H blood glucose. According to the OGTT results, the patients were divided into three groups: the normal glucose tolerance group (normal glucose tolerance, NGT), the IGR group. The patients were divided into etiological types.
Result:
1, 412 cases of AIS patients were collected continuously, effectively included in 372 patients with.372 AIS, and found AGR291 (78.2%) cases, including DM166 (44.6%), IGR125 (33.6%), of which I-IGT96 (25.8%), I-IFG6 (1.6%), compound glucose tolerance (IGT+IFG) 23 (6.2%), NGT81 (21.8%)), 94 (25.3%) patients who had been diagnosed as DM before admission. Patients without DM history were diagnosed before admission. According to FPG's newly diagnosed DM46 (12.4%), IGR29 (7.80%) cases, 203 cases underwent OGTT examination, and DM26 (6.99%) cases, IGR96 (25.8%) cases and NGT81 (21.8%) cases were found.
2, compared with OGTT, HbA1c screened the cut point of IGR (FPG or IGT) by 5.45% (sensitivity 84.8%, specificity 75%), and HbA1c for diagnosis of DM at 6.05% (sensitivity was 79.5%, specificity was 86.4%).
3, compared with the three groups, there was no statistically significant difference in body mass index, waist circumference, hip circumference, waist / hip circumference ratio, homocysteine (P > 0.05). Smoking, drinking, stroke history, and history of heart disease were not statistically significant (P > 0.05).
Group DM and group NGT were compared with group DM (X2=8.994, P=0.003), and the prevalence rate of drinking history (X2=5.594, P=0.014) was lower than that of group NGT, and the prevalence rate of hypertension (X2=7.004, P=0.006) was higher in men (X2=6.070, P=0.009) than in those in the group, and the difference was statistically significant. The prevalence rate of hyperlipidemia in the three groups was higher than that of the group (0.05) and the group ( P < 0.05), the incidence of hyperlipidemia in group IGR was higher than that in group NGT (P < 0.05) the level of glycated hemoglobin in group.DM was higher than that in group IGR (P < 0.01) and NGT group (P < 0.01), and the glycosylated hemoglobin in IGR group was higher than that in NGT group (P < 0.01).
4, older patients (older than 60 years old) and non elderly patients (60 years old), elderly patients (60 years old) with abnormal glucose metabolism rate is higher than non elderly patients (60 years of age) (X2=6.615, P=0.0370.05).
5 of the patients with AIS, 262 (70.4%) with large atherosclerotic cerebral infarction, 32 (8.6%) with cardiogenic cerebral infarction, 62 (16.7%) with perforator artery disease, 9 (2.4%) for other causes, and 7 (1.9%) in etiology, including 125 cases, atherosclerotic 90 (72.2%) cases, cardiogenic cerebral infarction, perforator artery disease and other original cases. Due to 3 (2.4%) cases, there were 1 (0.8%) cases of.DM, 118 (71.1%), 14 (8.4%), 27 (16.3%) of perforator artery disease and 1 (1.8%) of the other causes. The etiology of.IGR was not statistically significant (X2=1.663, P=0.797).
Conclusion:
1, the prevalence of AGR in AIS patients is higher..OGTT detection can detect more acute ischemic stroke patients with abnormal glucose metabolism than simple detection of fasting blood glucose.
2, patients aged above 60 years, with hyperlipidemia and HbA1c above 5.45% of acute ischemic stroke, suggest OGTT test to detect impaired glucose regulation in AIS patients.
3, C1SS atherosclerosis is the most common cause of acute ischemic stroke with abnormal glucose metabolism.
【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R743.3

【参考文献】