后循环脑梗死患者血清糖化血红蛋白水平与血管病变及预后的相关性

发布时间：2018-11-04 20:09

【摘要】：当今社会,缺血性脑血管病的发病率已位居威胁广大人民群众身体健康的三大致死性疾病首位[1]。伴随全球社会老龄化进程的持续推进和人口寿命的延长,缺血性脑血管病的发病率也屡创新高[2]。脑血管病具有四高(高发病率、高致死率、高致残率、高复发率)和逐渐年轻化的特点,严重的影响我国人民的身体健康,已经造成了严重的社会和家庭负担。因此,缺血性脑血管病的防治是海内外学者、科学家们亟待解决的重要课题。2型糖尿病被广泛认为是缺血性脑血管病的重要危险因素之一。糖化血红蛋白是血红蛋白和血液中的葡萄糖(或其他糖)结合、发生非酶催化反应的产物,是评价糖尿病血糖控制情况的“金标准”[3-4]。研究表明,卒中前血糖控制差(即:糖化血红蛋白高)与缺血性脑卒中的发生成正相关[5-6],可通过多种机制促进大动脉粥样硬化形成,是缺血性卒中的独立危险因素且更易引起后循环缺血性卒中[7]。本研究通过观察后循环脑梗死患者血清糖化血红蛋白水平与后循环血管病变严重程度、神经功能缺损程度、病情进展及预后的相关性,探讨糖化血红蛋白在后循环脑梗死发生发展过程中的作用。本研究是回顾性研究。收集2014年12月至2016年3月份,在河北省邢台市人民医院神经内科住院的急性后循环脑梗死119例。所有患者的临床表现符合我国2010年颁布《关于急性缺血性卒中的诊断标准》,并均经头颅核磁检查确诊。详实的采集患者的病例资料:性别、年龄、高血压病史、糖尿病病史、冠心病病史、吸烟、入院时血压等基本资料;化验检查:甘油三酯、胆固醇、低密度脂蛋白、同型半胱氨酸、空腹血糖、糖化血红蛋白;CTA(CT血管造影)或全脑血管造影(DSA)检查的结果;入院和出院NIHSS评分、30天mRS评分、是否出现病情进展等临床资料。根据入院时的血清糖化血红蛋白水平分为正常组(6.5%,60例)、轻度升高组(6.5%~8.5%,33例)、重度升高组(≥8.5%,26例);比较三组患者的性别、年龄、既往病史、吸烟、入院时血压、化验检查、糖尿病的发病率有无差别;分析糖化血红蛋白水平与血管狭窄程度、入出院NIHSS评分、30天mRS评分、病情进展情况的相关性。我们的研究发现三组间一般情况,无明显差异(P0.05);糖尿病病史、新发糖尿病、入院首次空腹血糖的比较,差异有统计学意义(P0.05)。三组间动脉血管狭窄程度的比例依次为轻度:61.7%、12.1%、3.8%;中度:13.3%、42.4%、50.0%;重度:25.0%、45.5%、46.2%,随着糖化血红蛋白水平的增高,轻度狭窄逐渐减少,中重度狭窄逐渐增加(P0.01,T=23.020);线性分析显示糖化血红蛋白水平和血管狭窄程度呈线性相关(x2=20.053,P0.01,r=0.495)。糖化血红蛋白水平低于8.5%对患者入院NIHSS评分影响相对较小,大于8.5%入院NIHSS评分重度升高组与正常组、轻度升高组相比有明显差异(P0.05);出院NIHSS评分和mRS评分随HbA1c水平升高而升高,三组间两两比较差异有统计学意义(P均0.05)。随着糖化血红蛋白水平升高,三组中病情进展的比例逐渐增加(P0.05),且糖化血红蛋白水平和病情进展呈线性相关(x2=26.606,P0.01,r=0.431)。我们的研究表明:后循环脑梗死患者血清糖化血红蛋白水平和血管动脉粥样硬化性狭窄的程度密切相关,并且糖化血红蛋白水平越高,患者的神经功能缺损越重,病情越容易进展,预后越差。因此,神经科专科医师在临床工作中应加强对后循环脑梗死的血糖管理,尤其重视对糖化血红蛋白的控制,加强健康教育,重视脑血管情况的筛查,从而阻止病情进展,改善预后。
[Abstract]:In today's society, the incidence of ischemic cerebrovascular disease has been the first to threaten the health of the masses of the masses[1]. Along with the sustained progress of the global social aging process and the extension of population life, the incidence of ischemic cerebrovascular disease is also higher than that of innovation[2]. Cerebrovascular disease has the characteristics of four high (high incidence, high incidence rate, high disability rate, high recurrence rate) and gradual rejuvenation, which seriously affects the health of our people and has caused serious social and family burden. Therefore, the prevention and cure of ischemic cerebrovascular disease is an important issue to be solved by scientists and scientists at home and abroad. Type 2 diabetes is widely regarded as one of the important risk factors of ischemic cerebrovascular disease. Glycosylated hemoglobin is a combination of hemoglobin and glucose (or other sugars) in blood, a product of non-enzymatic catalytic reaction, which is used to evaluate the glycemic control of diabetes" Gold Standard "[3-4]. Studies have shown that the difference in blood glucose control before stroke (i.e., high glycated hemoglobin) is positively correlated with the occurrence of ischemic stroke[5-6], which can promote the formation of aortic atherosclerosis through a variety of mechanisms, is an independent risk factor in ischemic stroke and is more susceptible to post-cyclic ischemic stroke[7]. Objective To investigate the relationship between serum glycated hemoglobin level and post-circulating vascular disease severity, neurological function defect degree, disease progression and prognosis in patients with post-circulating cerebral infarction, and to investigate the role of glycosylated hemoglobin in the development of post-circulating cerebral infarction. This study is a retrospective study. From December 2014 to March 2016, 119 patients with acute post-circulation cerebral infarction were admitted to the neurology department of the People's Hospital of the People's Hospital of Hebei Province. Clinical manifestations of all patients were consistent with our country's 2010 issue of diagnostic criteria for acute ischemic stroke> and were confirmed by head nuclear magnetic examination. Detailed patient data: gender, age, history of hypertension, history of diabetes, history of coronary heart disease, smoking, blood pressure during admission, etc.; laboratory tests: triglyceride, cholesterol, low density lipoprotein, homotype cysteine, fasting blood glucose, Results of glycosylated hemoglobin; CTA (CT angiography) or total angiography (DSA); clinical data on admission and discharge of NIHSS scores, 30-day mRS scores, progress in disease progression, etc. The levels of glycated hemoglobin at admission were divided into normal group (6.5%, 60 cases), mildly elevated group (6.5% ~ 8.5%, 33 cases), severe raised group (65.80.5%, 26 cases), comparing the sex, age, past medical history, smoking, blood pressure and laboratory examination of three groups of patients. There was no difference in the incidence of diabetes mellitus, and the correlation between the level of glycated hemoglobin and the degree of stenosis of blood vessels, NIHSS score, mRS score of 30 days and progression of disease were analyzed. We found that there was no significant difference between the three groups (P <0.05), the history of diabetes mellitus, the newly diagnosed type of diabetes mellitus and the first fasting blood glucose in the hospital were statistically significant (P0.05). The proportion of stenosis in three groups was mild: 61.7%, 12.1%, 30.8%, moderate: 13.3%, 42.4%, 50. 0%, severe: 25.0%, 44.5%, 46.2%. With the increase of glycosylated hemoglobin level, the mild stenosis gradually decreased, and the moderately severe stenosis gradually increased (P0.01). T = 23.020); linear analysis showed a linear correlation between glycated hemoglobin level and degree of vascular stenosis (x2 = 20.053, P0.01, r = 0.9495). The level of glycosylated hemoglobin was lower than that of 8. 5% had a relatively small impact on NIHSS score, more than 8. 5% had a significant difference in NIHSS score (P0.05), NIHSS score and mRS score increased with the increase of HbA1c level. There was significant difference between the three groups (P 0.05). As the level of glycated hemoglobin increased, the proportion of disease progression in three groups was gradually increased (P0.05), and the level of glycated hemoglobin and progression of the disease were linearly related (x2 = 26,606, P0.01, r = 0.9431). Our results show that the level of glycated hemoglobin and the degree of vascular atherosclerotic stenosis in the patients with post-circulating cerebral infarction are closely related, and the higher the glycated hemoglobin level, the more severe the neurological deficit of the patient, the easier it progresses and the worse prognosis. Therefore, neurologist should strengthen the management of blood sugar in post-circulating cerebral infarction in clinical work, pay special attention to the control of glycosylated hemoglobin, strengthen health education, pay attention to the screening of cerebral vascular condition, thus preventing disease progression and improving prognosis.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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