CAJ | 학술논문

目的：探讨血糖波动对急性脑梗死患者短期预后的影响。方法收集2013年1-11月入住北京军区总医院八一脑科医院的83例急性脑梗死,根据动态血糖监测系统( CGMS)测得的日内平均血糖波动幅度( MAGE)分为高MAGE组(MAGE≥3.9 mmol/L)45例、MAGE正常组(MAGE<3.9 mmol/L)38例,予专科治疗,同时依据合并症予相应的降压、降糖、扩张冠状动脉治疗。比较两组如下项目：有糖尿病病史患者百分率、血压及空腹血糖( FBG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血栓素A2( TXA2)；动态血糖参数：24 h 平均血糖值(24 h MBG )、MAGE、全天血糖标准差( SDBG )、血糖≥7.8 mmol/L的时间在24 h内所占的百分数(PT7.8)、血糖≤3.9 mmol/L的时间在24 h内所占的百分数(PT3.9)；入院起90 d内主要不良脑血管事件发生情况、90 d改良RANKIN量表( mRS)评分。对83例90 d mRS评分与各观察指标的相关性进行分析。结果高MAGE组有糖尿病病史者百分率、收缩压( SBP)、FBG、HbA1c、LDL-C、TXA2均显著高于MAGE正常组(P<0.01)；高MAGE组24 h MBG、SDBG、PT7.8均显著高于MAGE正常组(P<0.01)；高MAGE组90 d内不良脑血管事件发生率及90 d mRS评分显著高于MAGE正常组(P<0.01)；90 d mRS评分与TXA2、MAGE呈显著正相关(r=0.828、0.862,P<0.01),TXA2、MAGE与90 d mRS评分呈独立相关(Y=-3.081+0.359TXA2+0.292MAGE)。结论血糖波动明显的急性脑梗死患者预后较差,临床应重视监测此类患者的血糖波动情况,控制血糖波动幅度,以提高疗效,改善预后。
목적：탐토혈당파동대급성뇌경사환자단기예후적영향。방법수집2013년1-11월입주북경군구총의원팔일뇌과의원적83례급성뇌경사,근거동태혈당감측계통( CGMS)측득적일내평균혈당파동폭도( MAGE)분위고MAGE조(MAGE≥3.9 mmol/L)45례、MAGE정상조(MAGE<3.9 mmol/L)38례,여전과치료,동시의거합병증여상응적강압、강당、확장관상동맥치료。비교량조여하항목：유당뇨병병사환자백분솔、혈압급공복혈당( FBG)、당화혈홍단백(HbA1c)、감유삼지(TG)、총담고순(TC)、고밀도지단백담고순(HDL-C)、저밀도지단백담고순(LDL-C)、혈전소A2( TXA2)；동태혈당삼수：24 h 평균혈당치(24 h MBG )、MAGE、전천혈당표준차( SDBG )、혈당≥7.8 mmol/L적시간재24 h내소점적백분수(PT7.8)、혈당≤3.9 mmol/L적시간재24 h내소점적백분수(PT3.9)；입원기90 d내주요불량뇌혈관사건발생정황、90 d개량RANKIN량표( mRS)평분。대83례90 d mRS평분여각관찰지표적상관성진행분석。결과고MAGE조유당뇨병병사자백분솔、수축압( SBP)、FBG、HbA1c、LDL-C、TXA2균현저고우MAGE정상조(P<0.01)；고MAGE조24 h MBG、SDBG、PT7.8균현저고우MAGE정상조(P<0.01)；고MAGE조90 d내불량뇌혈관사건발생솔급90 d mRS평분현저고우MAGE정상조(P<0.01)；90 d mRS평분여TXA2、MAGE정현저정상관(r=0.828、0.862,P<0.01),TXA2、MAGE여90 d mRS평분정독립상관(Y=-3.081+0.359TXA2+0.292MAGE)。결론혈당파동명현적급성뇌경사환자예후교차,림상응중시감측차류환자적혈당파동정황,공제혈당파동폭도,이제고료효,개선예후。
Objective To explore the influence of blood sugar fluctuation on short-term prognoses of patients with acute cerebral infarction. Methods A total of 83 patients with acute cerebral infarction from January to November 2013 were divided into high mean amplitude of glycemic excursions (MAGE) group (n=45, MAGE≥3. 9 mmol/L)and normal MAGE group (n=38, MAGE<3. 9 mmol/L) according the MAGE results by continuous glucose monitoring sys-tem ( CGMS) , and all the patients underwent special treatment and the corresponding treatments of decreasing blood pres-sure and blood sugar, and expansion of coronary artery on the basis of complications at the same time. The levels of per-centage of patients with a history of diabetes, blood pressure, fasting blood glucose (FBG), glycosylated hemoglobin (HbA1C), triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipo-protein cholesterol ( LDL-C) and thromboxane A2 ( TXA2 ) in the two groups were compared; the levels of 24 h mean blood glucose (MBG), MAGE, standard deviation of blood glucose (SDBG), percentage of the time of blood glucose value≥7. 8 mmol/L to the 24 h (PT7. 8) and percentage of the time of blood glucose value ≤3. 9 mmol/L to the 24 h ( PT3. 9) in the two groups were also compared;the incidence rate of main adverse cerebrovascular events within 90 d of admission and 90 d of modificatory RANKIN score ( mRS) were also compared. The correlations between 90 d of mRS score and the indexes were analyzed for the 83 patients. Results Compared with those in normal MAGE group, in high MAGE group, the levels of percentage of patients with a history of diabetes, systolic blood pressure ( SBP ) , FBG, HbA1C, LDL-C and TXA2 were significantly higher;the levels of 24 h MBG, SDBG and PT7. 8 were significantly higher ( P<0. 01);the levels of incidence rate of main adverse cerebrovascular events within 90 d of admission and 90 d mRS score were significantly higher (P<0. 01);the value of 90 d mRS scores was positively related to the values of TXA2 and MAGE (r=0. 828, 0. 862, P<0. 01), and values of TXA2 and MAGE was independently related to the value of 90 d mRS score (Y= -3. 081+0. 359TXA2 +0. 292MAGE). Conclusion Significant blood sugar fluctuation may lead to poor prognosis in patients with acute cerebral infarction, so clinicians should pay more attention to monitoring blood sugar fluctuation and controlling blood sugar fluctuation in order to improve the efficacy and prognosis.