CAJ | 학술논문

目的：探究糖代谢异常对慢性缺血性脑白质疏松（LA）的影响。方法回顾性分析2013年6月～12月中国医科大学附属第四医院神经内科收治的258例缺血性脑血管疾病患者的临床资料。根据病史及化验结果将糖代谢情况分为正常糖代谢、2型糖尿病以及前驱期糖尿病，依据头MRI结果对LA严重程度进行分级，分析比较不同糖代谢情况以及不同血糖化验指标（包括FPG、2hPG及HbA1c）对慢性缺血性脑白质疏松及其严重程度的影响。结果单因素分析显示，慢性缺血性脑白质疏松的相关危险因素有年龄、高血压病史、糖尿病病史、糖代谢异常、甘油三酯、2hPG（OR＞1，P＜0.05）。Logistic回归分析显示脑白质疏松与年龄、高血压病史、2hPG相关（P＜0.05）。Spearman秩相关检验显示LA严重程度分级与年龄大小、高血压病史时长、2hPG水平呈正相关，与HDL、apoA、腔梗病史呈负相关（P＜0.05，r=0.402、0.227、0.135、-0.154、-0.147、-0.312）。结论年龄、高血压病史、糖尿病病史、糖代谢异常、2hPG、甘油三酯是脑白质疏松的危险因素；年龄越大、高血压病史时间越长、2hPG越高、HDL及apoA越低，脑白质疏松越严重；而FPG、HbA1c、前驱期糖尿病、糖尿病及其时长与脑白质疏松的严重程度无相关性。
목적：탐구당대사이상대만성결혈성뇌백질소송（LA）적영향。방법회고성분석2013년6월～12월중국의과대학부속제사의원신경내과수치적258례결혈성뇌혈관질병환자적림상자료。근거병사급화험결과장당대사정황분위정상당대사、2형당뇨병이급전구기당뇨병，의거두MRI결과대LA엄중정도진행분급，분석비교불동당대사정황이급불동혈당화험지표（포괄FPG、2hPG급HbA1c）대만성결혈성뇌백질소송급기엄중정도적영향。결과단인소분석현시，만성결혈성뇌백질소송적상관위험인소유년령、고혈압병사、당뇨병병사、당대사이상、감유삼지、2hPG（OR＞1，P＜0.05）。Logistic회귀분석현시뇌백질소송여년령、고혈압병사、2hPG상관（P＜0.05）。Spearman질상관검험현시LA엄중정도분급여년령대소、고혈압병사시장、2hPG수평정정상관，여HDL、apoA、강경병사정부상관（P＜0.05，r=0.402、0.227、0.135、-0.154、-0.147、-0.312）。결론년령、고혈압병사、당뇨병병사、당대사이상、2hPG、감유삼지시뇌백질소송적위험인소；년령월대、고혈압병사시간월장、2hPG월고、HDL급apoA월저，뇌백질소송월엄중；이FPG、HbA1c、전구기당뇨병、당뇨병급기시장여뇌백질소송적엄중정도무상관성。
Objective To explore the impacts of abnormal glucose metabolism on chronic ischemic leukoaraiosis (LA).Methods The clinical data of 258 patients with ischemic cerebrovascular disease were analyzed who were cured in the Fourth Affi liated Hospital of China Medical University from Jun to December in 2013. According to the medical history and laboratory reports, these patients were divided into normal glucose metabolism group, type 2 diabetes group and pre-diabetes group. Based on the results of head MRI, the severity of leukoaraiosis was graded. Then we compared and analyzed the impacts of different glucose metabolism and different glycemic indexes on chronic ischemic leukoaraiosis and its severity; the glycemic indexes including FPG, 2hPG and HbA1c.Results Univariate analysis showed that age, diabetes history, abnormal glucose metabolism, hypertension history, triglycerides and 2hPG were the risk factors associated with chronic ischemic leukoaraiosis (OR>1,P<0.05). Logistic regression analysis showed that leukoaraiosis was correlated with age, hypertension history, 2hPG levels (P<0.05). Spearman rank correlation analysis showed that the severity of leukoaraiosis was positively correlated with age, the length of hypertension history and 2hPG levels, and was negatively correlated with HDL levels, apoA levels and lacunar infarct history (P<0.05,r=0.402, 0.227, 0.135, -0.154, -0.147, -0.312). Conclusion The risk factors of chronic ischemic leukoaraiosis are as follows: age, hypertension history, diabetes history, abnormal glucose metabolism, triglycerides and 2hPG. Leukoaraiosis is positively rank correlated with age, diabetes history, hypertension history and the levels of triglycerides and 2hPG, while is negatively rank correlated with the levels of HDL and apoA. The severity of leukoaraiosis has no correlation with FPG, HbA1c, pre-diabetes, diabetes history and its length.