CAJ | 학술논문

目的：观察糖尿病与脑梗死后应激性高血糖对急性脑梗死溶栓效果和短期预后的影响。方法回顾性纳入2012年1月-2013年8月于北京军区总医院接受阿替普酶溶栓治疗的急性期脑梗死(≤4．5 h)患者127例。根据有无糖尿病史、入院时随机血糖及7 d后口服葡萄糖耐量试验,将其分为糖尿病组(35例),应激性高血糖组(49例)及血糖正常组(43例)。比较溶栓后24 h两组的美国国立卫生研究院卒中量表( NIHSS)评分、血管再通率及90 d的改良Rankin量表( mRS)评分。结果溶栓前,糖尿病组、应激性高血糖组及血糖正常组NIHSS评分分别为(14．2±5．1)、(12．8±5．6)、(13．0±4．6)分,差异无统计学意义(P>0．05)；溶栓后24h,分别为(14．7±6．0)、(11．9±4．9)、(8．0±2．9)分,差异有统计学意义(P<0．05),其中糖尿病组和应激性高血糖组的NIHSS评分与溶栓前比较差异无统计学意义( P>0．05)；血糖正常组NIHSS评分低于溶栓前,差异有统计学意义( P<0．05)。溶栓后3组再通良好率分别为54．3%(19例)、57．2%(28例)、67．4%(29例),出血转化率分别为14．3%(5例)、6．1%(3例)、2．3%(1例),差异均无统计学意义。溶栓后90 d 3组mRS评分显示,血糖正常组的预后良好率为72．1%(31例),显著高于应激性高血糖组的51．0%(25例)和糖尿病组的28．6%(10例),差异有统计学意义(P<0．05,P<0．01)。应激性高血糖组与糖尿病组比较,差异也有统计学意义( P<0．05)。结论糖尿病与应激性高血糖均对急性期脑梗死溶栓治疗的效果和短期预后有不同程度的不良影响。
목적：관찰당뇨병여뇌경사후응격성고혈당대급성뇌경사용전효과화단기예후적영향。방법회고성납입2012년1월-2013년8월우북경군구총의원접수아체보매용전치료적급성기뇌경사(≤4．5 h)환자127례。근거유무당뇨병사、입원시수궤혈당급7 d후구복포도당내량시험,장기분위당뇨병조(35례),응격성고혈당조(49례)급혈당정상조(43례)。비교용전후24 h량조적미국국립위생연구원졸중량표( NIHSS)평분、혈관재통솔급90 d적개량Rankin량표( mRS)평분。결과용전전,당뇨병조、응격성고혈당조급혈당정상조NIHSS평분분별위(14．2±5．1)、(12．8±5．6)、(13．0±4．6)분,차이무통계학의의(P>0．05)；용전후24h,분별위(14．7±6．0)、(11．9±4．9)、(8．0±2．9)분,차이유통계학의의(P<0．05),기중당뇨병조화응격성고혈당조적NIHSS평분여용전전비교차이무통계학의의( P>0．05)；혈당정상조NIHSS평분저우용전전,차이유통계학의의( P<0．05)。용전후3조재통량호솔분별위54．3%(19례)、57．2%(28례)、67．4%(29례),출혈전화솔분별위14．3%(5례)、6．1%(3례)、2．3%(1례),차이균무통계학의의。용전후90 d 3조mRS평분현시,혈당정상조적예후량호솔위72．1%(31례),현저고우응격성고혈당조적51．0%(25례)화당뇨병조적28．6%(10례),차이유통계학의의(P<0．05,P<0．01)。응격성고혈당조여당뇨병조비교,차이야유통계학의의( P<0．05)。결론당뇨병여응격성고혈당균대급성기뇌경사용전치료적효과화단기예후유불동정도적불량영향。
Objective To observe the impact of diabetes and stress hyperglycemia on thrombolytic effect and short-term prognosis in patients with acute cerebral infarction. Methods A total of 127 patients with acute cerebral infarction (≤4. 5 h) who received thrombolytic therapy with alteplase at General Hospital of Beijing Military Command from January 2012 to August 2013 were enrolled retrospectively. They were divided into three groups:Diabetes group (n=35),stress hyperglycemia group (n=49),and normal glucose group (n=43) according to whether they had a history of diabetes,random glucose on admission, and oral glucose tolerance test at day 7. At 24 h after thrombolysis,the National Institute of Health Stroke Scale (NIHSS) scores,recanalization rate,and the modified Rankin Scale (mRS) scores at day 90 were compared between the 2 groups. Results Before thrombolysis,the NIHSS scores of the diabetic group, stress hyperglycemia group,and normal glucose group were 14. 2 ± 5. 1,12. 8 ± 5. 6,and 13. 0 ± 4. 6,respectively (P>0.05);at 24 h after thrombolysis,they were 14.7 ±6.0,11.9 ±4.9,and 8.0 ±2.9,respectively (P<0.05);compared with before thrombolysis,the NIHSS scores of the diabetes group and the stress hyperglycemia group had no significant change (P>0. 05);the NIHSS score of the normal glucose group was lower than before thrombolysis. There was significant difference (P <0. 05). After thrombolysis,the patients with good recanalization were 54. 3% (n=19),57. 1% (n=28),and 67. 4% (n=29),respectively in the three groups;the hemorrhagic conversion rate was 14. 3% (n=5),6. 1% (n=3),and 2. 3% (n=1),respectively. There were no significant differences. At day 90 after thrombolysis,the mRS scores in the 3 groups showed that the good prognosis rate of the normal glucose group was 72. 1% (n=31);it was significantly higher than 51. 0% (n=25) of the stress hyperglycemia group and 29. 6% (n=10) of the diabetes group. There were significant differences (P<0. 05,P<0. 01). There was also significant difference between the stress hyperglycemia group and the diabetes group. Conclusion Diabetes and stress hyperglycemia have varying degrees of adverse effects on the efficacy and prognosis of the thrombolytic therapy for acute cerebral infarction.