CAJ | 학술논문

目的：研究血糖波动对急性脑梗死溶栓治疗预后的影响。方法回顾性连续纳入2013年1-11月入住北京军区总医院神经外科(附属八一脑科医院)的83例急性脑梗死患者,给予患者阿替普酶静脉溶栓治疗,剂量为0.9 mg/kg体质量。将患者按照有无糖尿病史及入院7 d后口服葡萄糖耐量试验结果分为2型糖尿病合并脑梗死组( DMCI组)47例与非2型糖尿病合并脑梗死组(NDMCI组)36例,入院7 d后应用动态血糖监测系统(CGMS)对入选患者进行连续72 h的血糖监测。观察并比较两组患者的平均血糖值、血糖水平的标准差、平均血糖波动幅度及随访期间脑出血转化及血管再通情况,并行90 d改良Rankin量表(mRS)评分评价其预后。结果(1)两组急性脑梗死患者动态血糖参数的比较,DMCI组患者24 h平均血糖值、血糖水平标准差、平均血糖波动幅度均高于NDMCI组患者[(8．3±2．6) mmol/L比(5．8±1．3) mmol/L,(2．1±0．4) mmol/L比(1．6±0．6) mmol/L,(4．3±0．8) mmol/L比(3．6±0．5) mmol/L],差异有统计学意义( t 值分别为31．419、15．537、15．372,均P<0．01)。(2)DMCI组随访期间发生脑出血转化4例(8．5%),再通良好17例(36．2%),预后良好(90 d mRS评分<2分)15例(31．9%)；NDMCI组发生脑出血转化1例(2．8%),再通良好21例(58．3%),预后良好21例(58．3%)。两组患者溶栓后再通情况与预后情况比较,差异有统计学意义(P<0．05)。结论伴有2型糖尿病的急性脑梗死患者血糖波动过大,可能是影响其溶栓治疗预后的重要因素。
목적：연구혈당파동대급성뇌경사용전치료예후적영향。방법회고성련속납입2013년1-11월입주북경군구총의원신경외과(부속팔일뇌과의원)적83례급성뇌경사환자,급여환자아체보매정맥용전치료,제량위0.9 mg/kg체질량。장환자안조유무당뇨병사급입원7 d후구복포도당내량시험결과분위2형당뇨병합병뇌경사조( DMCI조)47례여비2형당뇨병합병뇌경사조(NDMCI조)36례,입원7 d후응용동태혈당감측계통(CGMS)대입선환자진행련속72 h적혈당감측。관찰병비교량조환자적평균혈당치、혈당수평적표준차、평균혈당파동폭도급수방기간뇌출혈전화급혈관재통정황,병행90 d개량Rankin량표(mRS)평분평개기예후。결과(1)량조급성뇌경사환자동태혈당삼수적비교,DMCI조환자24 h평균혈당치、혈당수평표준차、평균혈당파동폭도균고우NDMCI조환자[(8．3±2．6) mmol/L비(5．8±1．3) mmol/L,(2．1±0．4) mmol/L비(1．6±0．6) mmol/L,(4．3±0．8) mmol/L비(3．6±0．5) mmol/L],차이유통계학의의( t 치분별위31．419、15．537、15．372,균P<0．01)。(2)DMCI조수방기간발생뇌출혈전화4례(8．5%),재통량호17례(36．2%),예후량호(90 d mRS평분<2분)15례(31．9%)；NDMCI조발생뇌출혈전화1례(2．8%),재통량호21례(58．3%),예후량호21례(58．3%)。량조환자용전후재통정황여예후정황비교,차이유통계학의의(P<0．05)。결론반유2형당뇨병적급성뇌경사환자혈당파동과대,가능시영향기용전치료예후적중요인소。
Objective To study the effect of blood glucose fluctuations on the prognosis of thrombolytic therapy in patients with acute cerebral infarction. Methods A total of 83 consecutive patients with acute cerebral infarction admitted to the Department of Neurology,General Hospital of Beijing Military Command ( the Affiliated 81st Brain Hospital ) from January to November 2013 were enrolled retrospectively. They were divided into cerebral infarction with type 2 diabetes mellitus group (DMCI group,n=47) and cerebral infarction without type 2 diabetes mellitus group (NDMCI group,n=36) according to whether they had diabetes mellitus or not and the results of oral glucose tolerance test at day 7 after admission. Continuous glucose monitoring system ( CGMS) was used to monitor glucose for 72 hours at day 7 after admission. The mean blood glucose, standard deviation of blood glucose level, mean blood glucose fluctuation,and hemorrhagic transformation during the follow-up period,as well as vascular recanalization were observed and compared. At day 90,the modified Rankin scale (mRS) score was used to evaluate the prognosis of the patients. Results ( 1 ) Comparing the dynamic glucose parameters of the patients with acute cerebral infarction in both groups,the mean blood glucose,standard deviation of blood glucose level,mean blood glucose fluctuations at 24 hours in patients of the DMCI group were higher than those of the NDMCI group ( 8 . 3 ± 2 . 6 mmol/L vs. 5 . 8 ± 1 . 3 mmol/L,2. 1 ± 0. 4 mmol/L vs. 1. 6 ± 0. 6 mmol/L,4. 3 ± 0. 8 mmol/L vs. 3. 6 ± 0. 5 mmol/L). There were significant differences (t=31. 419, 15.537,and 15. 372,respectively;all P<0. 01). (2) Four patients (8.5%) in the DMCI group had hemorrhagic transformation during the follow-up period,17 cases (36. 2%) had good recanalization,and 15 cases (31.9%) had good prognosis (the mRS score < 2 at day 90);1 patient (2.8%) in the NDMCI group had hemorrhagic transformation,21 patients (58. 3%) had good recanalization,and 21 cases (58. 3%) had good prognosis. There was significant difference between the recanalization after thrombolysis and the prognosis in patients of both groups (P<0. 05). Conclusion The great fluctuations of blood glucose in acute cerebral infarction patients with type 2 diabetes mellitus may be an important factor of affecting its prognosis of thrombolytic therapy.