本文選題：急性缺血性卒中 + 口服葡萄糖耐量試驗(yàn)　； 參考：《河南科技大學(xué)》2013年碩士論文

【摘要】：目的：第一：調(diào)查急性缺血性卒中(acute ischemic stroke，AIS)患者糖代謝異常（abnormal glucose regulation，AGR）的患病率；第二：研究伴糖調(diào)節(jié)受損（impaired glucose regulation,IGR）的AIS患者的人口學(xué)特征、臨床特征；第三：探討伴有AGR的AIS患者的病因。 方法：采用橫斷面研究設(shè)計(jì)，連續(xù)入選2011年10月～2012年10月在河南科技大學(xué)第一附屬醫(yī)院住院的急性缺血性卒中患者為研究對(duì)象，并經(jīng)頭顱核磁共振（magnetic resonance imaging，MRI）證實(shí)。記錄患者的人口學(xué)特征（年齡、性別、身高、體重、血壓、腰圍、臀圍），危險(xiǎn)因素（糖尿病(diabetesmellitus，DM)史、高血壓史、心臟病史，吸煙、飲酒史，記錄各項(xiàng)生化指標(biāo)（空腹血糖(fasting plasma glucose，F(xiàn)PG),糖化血紅蛋白，甘油三脂，總膽固醇，低密度脂蛋白,同型半胱氨酸）。對(duì)無糖尿病史的患者于發(fā)病后（7±3）天行口服OGTT(oral glucose tolerance test)檢測(cè)空腹和餐后2h血糖，根據(jù)OGTT結(jié)果將患者分為三組：糖耐量正常組（normal glucose tolerance，NGT）、IGR組(IFG、IGT、IFG+IGT)、DM組。并根據(jù)中國(guó)缺血性卒中亞型（Chinese Ischemic StrokeSubclassification，CISS）標(biāo)準(zhǔn)對(duì)伴AGR的AIS患者進(jìn)行病因分型。 結(jié)果： 1、連續(xù)收集AIS患者412例，有效納入372例患者。372例AIS患者中，發(fā)現(xiàn)AGR291（78.2%）例，其中DM166（44.6%）例，IGR125(33.6%)例，其中I-IGT96（25.8%）例，I-IFG6（1.6%）例，復(fù)合性糖耐量受損（IGT+IFG）23（6.2%）例，NGT81(21.8%)例。入院前已被診斷DM的患者94(25.3%)例，無DM史的患者根據(jù)FPG新診斷DM46（12.4%）例，IGR29(7.80%)例，203例行OGTT檢查，又發(fā)現(xiàn)DM26(6.99%)例，IGR96(25.8%)例,NGT81(21.8%)例。 2、與OGTT比較,HbA1c篩查IGR(FPG或IGT)的切點(diǎn)5.45%（靈敏度為84.8%，特異度為75.0%）；HbA1c診斷DM的切點(diǎn)6.05%（靈敏度為79.5%，特異度為86.4%）。 3、三組間比較，體質(zhì)指數(shù)、腰圍、臀圍、腰圍/臀圍比值，同型半胱氨酸，差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。吸煙，飲酒，卒中史、心臟病史患病率無統(tǒng)計(jì)學(xué)意義(p＞0.05)。 DM組與NGT組比較，DM組吸煙史（X2=8.994，P=0.003）、飲酒史（X2=5.594，P=0.014）患病率均低于NGT組，而男性（X2=6.070，P=0.009）、高血壓史（X2=7.004，P=0.006）患病率高于NGT組，差異有統(tǒng)計(jì)學(xué)意義；三組間兩兩比較，DM組高脂血癥患病率分別高于IGR組（p＜0.05）和NGT組（p＜0.05），IGR組高脂血癥患病率高于NGT組（p＜0.05）。DM組糖化血紅蛋白水平分別高于IGR組（p＜0.01）和NGT組（p＜0.01），IGR組糖化血紅蛋白高于NGT組（p＜0.01）。 4、老年患者(≥60歲)與非老年患者(60歲)比較，老年患者(≥60歲)糖代謝異�；疾÷矢哂诜抢夏昊颊�(60歲)（X2=6.615,P=0.0370.05）。 5、AIS患者中，大動(dòng)脈粥樣硬化性腦梗死262（70.4%）例，心源性腦梗死32（8.6%）例，穿支動(dòng)脈疾病62（16.7%）例，其他原因9（2.4%）例，病因不明確7（1.9%）例。其中IGR患者125例，大動(dòng)脈粥樣硬化90（72.2%）例，心源性腦梗死13（10.4%）例，穿支動(dòng)脈疾病18（14.4%）例，其他原因3（2.4%）例，病因不明確1（0.8%）例。DM患者166例，大動(dòng)脈粥樣硬化118（71.1%）例，心源性腦梗死14（8.4%）例，穿支動(dòng)脈疾病27（16.3%）例，其他原因3（1.8%）例，病因不明確4（2.4%）例。IGR組與DM比較，病因?qū)W分型無統(tǒng)計(jì)學(xué)意義（X2=1.663,P=0.797）。 結(jié)論： 1、AIS患者AGR患病率較高。OGTT檢測(cè)比單純檢測(cè)空腹血糖可發(fā)現(xiàn)更多伴糖代謝異常的急性缺血性卒中患者。 2、年齡≥60歲，伴高脂血癥，HbA1c≥5.45%的急性缺血性卒中患者建議行OGTT檢測(cè)以發(fā)現(xiàn)AIS中伴糖調(diào)節(jié)受損的患者。 3、C1SS分型中大動(dòng)脈粥樣硬化是伴糖代謝異常的急性缺血性卒中患者最常見病因類型。
[Abstract]:Objective: First: To investigate the prevalence of abnormal glucose metabolism (abnormal glucose regulation, AGR) in patients with acute ischemic stroke (acute ischemic stroke, AIS); second: To study the demographic characteristics and clinical characteristics of patients with impaired glucose regulation (impaired glucose regulation, IGR); and third.
Methods: using cross-sectional study and design, the patients with acute ischemic stroke hospitalized in the First Affiliated Hospital of Henan University of Science and Technology from October 2011 to October 2012 were selected and confirmed by magnetic resonance imaging (MRI). The demographic characteristics of patients (age, sex, height, weight, blood pressure, waist) were recorded. Peri, hip circumference, risk factors (diabetesmellitus, DM) history, hypertension history, heart disease history, smoking, drinking history, record all biochemical indexes (fasting blood glucose (fasting plasma glucose, FPG), glycated hemoglobin, glycerol three fat, total cholesterol, low density lipoprotein, homocysteine). (7 + 3) for patients without diabetes. OGTT (oral glucose tolerance test) was used to detect the fasting and postprandial 2H blood glucose. According to the OGTT results, the patients were divided into three groups: the normal glucose tolerance group (normal glucose tolerance, NGT), the IGR group. The patients were divided into etiological types.
Result:
1, 412 cases of AIS patients were collected continuously, effectively included in 372 patients with.372 AIS, and found AGR291 (78.2%) cases, including DM166 (44.6%), IGR125 (33.6%), of which I-IGT96 (25.8%), I-IFG6 (1.6%), compound glucose tolerance (IGT+IFG) 23 (6.2%), NGT81 (21.8%)), 94 (25.3%) patients who had been diagnosed as DM before admission. Patients without DM history were diagnosed before admission. According to FPG's newly diagnosed DM46 (12.4%), IGR29 (7.80%) cases, 203 cases underwent OGTT examination, and DM26 (6.99%) cases, IGR96 (25.8%) cases and NGT81 (21.8%) cases were found.
2, compared with OGTT, HbA1c screened the cut point of IGR (FPG or IGT) by 5.45% (sensitivity 84.8%, specificity 75%), and HbA1c for diagnosis of DM at 6.05% (sensitivity was 79.5%, specificity was 86.4%).
3, compared with the three groups, there was no statistically significant difference in body mass index, waist circumference, hip circumference, waist / hip circumference ratio, homocysteine (P > 0.05). Smoking, drinking, stroke history, and history of heart disease were not statistically significant (P > 0.05).
Group DM and group NGT were compared with group DM (X2=8.994, P=0.003), and the prevalence rate of drinking history (X2=5.594, P=0.014) was lower than that of group NGT, and the prevalence rate of hypertension (X2=7.004, P=0.006) was higher in men (X2=6.070, P=0.009) than in those in the group, and the difference was statistically significant. The prevalence rate of hyperlipidemia in the three groups was higher than that of the group (0.05) and the group ( P < 0.05), the incidence of hyperlipidemia in group IGR was higher than that in group NGT (P < 0.05) the level of glycated hemoglobin in group.DM was higher than that in group IGR (P < 0.01) and NGT group (P < 0.01), and the glycosylated hemoglobin in IGR group was higher than that in NGT group (P < 0.01).
4, older patients (older than 60 years old) and non elderly patients (60 years old), elderly patients (60 years old) with abnormal glucose metabolism rate is higher than non elderly patients (60 years of age) (X2=6.615, P=0.0370.05).
5 of the patients with AIS, 262 (70.4%) with large atherosclerotic cerebral infarction, 32 (8.6%) with cardiogenic cerebral infarction, 62 (16.7%) with perforator artery disease, 9 (2.4%) for other causes, and 7 (1.9%) in etiology, including 125 cases, atherosclerotic 90 (72.2%) cases, cardiogenic cerebral infarction, perforator artery disease and other original cases. Due to 3 (2.4%) cases, there were 1 (0.8%) cases of.DM, 118 (71.1%), 14 (8.4%), 27 (16.3%) of perforator artery disease and 1 (1.8%) of the other causes. The etiology of.IGR was not statistically significant (X2=1.663, P=0.797).
Conclusion:
1, the prevalence of AGR in AIS patients is higher..OGTT detection can detect more acute ischemic stroke patients with abnormal glucose metabolism than simple detection of fasting blood glucose.
2, patients aged above 60 years, with hyperlipidemia and HbA1c above 5.45% of acute ischemic stroke, suggest OGTT test to detect impaired glucose regulation in AIS patients.
3, C1SS atherosclerosis is the most common cause of acute ischemic stroke with abnormal glucose metabolism.
【學(xué)位授予單位】：河南科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R743.3

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