后循環(huán)腦梗死患者血清糖化血紅蛋白水平與血管病變及預(yù)后的相關(guān)性
發(fā)布時(shí)間：2018-11-04 20:09
【摘要】：當(dāng)今社會(huì),缺血性腦血管病的發(fā)病率已位居威脅廣大人民群眾身體健康的三大致死性疾病首位[1]。伴隨全球社會(huì)老齡化進(jìn)程的持續(xù)推進(jìn)和人口壽命的延長(zhǎng),缺血性腦血管病的發(fā)病率也屢創(chuàng)新高[2]。腦血管病具有四高(高發(fā)病率、高致死率、高致殘率、高復(fù)發(fā)率)和逐漸年輕化的特點(diǎn),嚴(yán)重的影響我國(guó)人民的身體健康,已經(jīng)造成了嚴(yán)重的社會(huì)和家庭負(fù)擔(dān)。因此,缺血性腦血管病的防治是海內(nèi)外學(xué)者、科學(xué)家們亟待解決的重要課題。2型糖尿病被廣泛認(rèn)為是缺血性腦血管病的重要危險(xiǎn)因素之一。糖化血紅蛋白是血紅蛋白和血液中的葡萄糖(或其他糖)結(jié)合、發(fā)生非酶催化反應(yīng)的產(chǎn)物,是評(píng)價(jià)糖尿病血糖控制情況的“金標(biāo)準(zhǔn)”[3-4]。研究表明,卒中前血糖控制差(即:糖化血紅蛋白高)與缺血性腦卒中的發(fā)生成正相關(guān)[5-6],可通過(guò)多種機(jī)制促進(jìn)大動(dòng)脈粥樣硬化形成,是缺血性卒中的獨(dú)立危險(xiǎn)因素且更易引起后循環(huán)缺血性卒中[7]。本研究通過(guò)觀察后循環(huán)腦梗死患者血清糖化血紅蛋白水平與后循環(huán)血管病變嚴(yán)重程度、神經(jīng)功能缺損程度、病情進(jìn)展及預(yù)后的相關(guān)性,探討糖化血紅蛋白在后循環(huán)腦梗死發(fā)生發(fā)展過(guò)程中的作用。本研究是回顧性研究。收集2014年12月至2016年3月份,在河北省邢臺(tái)市人民醫(yī)院神經(jīng)內(nèi)科住院的急性后循環(huán)腦梗死119例。所有患者的臨床表現(xiàn)符合我國(guó)2010年頒布《關(guān)于急性缺血性卒中的診斷標(biāo)準(zhǔn)》,并均經(jīng)頭顱核磁檢查確診。詳實(shí)的采集患者的病例資料:性別、年齡、高血壓病史、糖尿病病史、冠心病病史、吸煙、入院時(shí)血壓等基本資料;化驗(yàn)檢查:甘油三酯、膽固醇、低密度脂蛋白、同型半胱氨酸、空腹血糖、糖化血紅蛋白;CTA(CT血管造影)或全腦血管造影(DSA)檢查的結(jié)果;入院和出院NIHSS評(píng)分、30天mRS評(píng)分、是否出現(xiàn)病情進(jìn)展等臨床資料。根據(jù)入院時(shí)的血清糖化血紅蛋白水平分為正常組(6.5%,60例)、輕度升高組(6.5%~8.5%,33例)、重度升高組(≥8.5%,26例);比較三組患者的性別、年齡、既往病史、吸煙、入院時(shí)血壓、化驗(yàn)檢查、糖尿病的發(fā)病率有無(wú)差別;分析糖化血紅蛋白水平與血管狹窄程度、入出院NIHSS評(píng)分、30天mRS評(píng)分、病情進(jìn)展情況的相關(guān)性。我們的研究發(fā)現(xiàn)三組間一般情況,無(wú)明顯差異(P0.05);糖尿病病史、新發(fā)糖尿病、入院首次空腹血糖的比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。三組間動(dòng)脈血管狹窄程度的比例依次為輕度:61.7%、12.1%、3.8%;中度:13.3%、42.4%、50.0%;重度:25.0%、45.5%、46.2%,隨著糖化血紅蛋白水平的增高,輕度狹窄逐漸減少,中重度狹窄逐漸增加(P0.01,T=23.020);線性分析顯示糖化血紅蛋白水平和血管狹窄程度呈線性相關(guān)(x2=20.053,P0.01,r=0.495)。糖化血紅蛋白水平低于8.5%對(duì)患者入院NIHSS評(píng)分影響相對(duì)較小,大于8.5%入院NIHSS評(píng)分重度升高組與正常組、輕度升高組相比有明顯差異(P0.05);出院NIHSS評(píng)分和mRS評(píng)分隨HbA1c水平升高而升高,三組間兩兩比較差異有統(tǒng)計(jì)學(xué)意義(P均0.05)。隨著糖化血紅蛋白水平升高,三組中病情進(jìn)展的比例逐漸增加(P0.05),且糖化血紅蛋白水平和病情進(jìn)展呈線性相關(guān)(x2=26.606,P0.01,r=0.431)。我們的研究表明:后循環(huán)腦梗死患者血清糖化血紅蛋白水平和血管動(dòng)脈粥樣硬化性狹窄的程度密切相關(guān),并且糖化血紅蛋白水平越高,患者的神經(jīng)功能缺損越重,病情越容易進(jìn)展,預(yù)后越差。因此,神經(jīng)科�？漆t(yī)師在臨床工作中應(yīng)加強(qiáng)對(duì)后循環(huán)腦梗死的血糖管理,尤其重視對(duì)糖化血紅蛋白的控制,加強(qiáng)健康教育,重視腦血管情況的篩查,從而阻止病情進(jìn)展,改善預(yù)后。
[Abstract]:In today's society, the incidence of ischemic cerebrovascular disease has been the first to threaten the health of the masses of the masses[1]. Along with the sustained progress of the global social aging process and the extension of population life, the incidence of ischemic cerebrovascular disease is also higher than that of innovation[2]. Cerebrovascular disease has the characteristics of four high (high incidence, high incidence rate, high disability rate, high recurrence rate) and gradual rejuvenation, which seriously affects the health of our people and has caused serious social and family burden. Therefore, the prevention and cure of ischemic cerebrovascular disease is an important issue to be solved by scientists and scientists at home and abroad. Type 2 diabetes is widely regarded as one of the important risk factors of ischemic cerebrovascular disease. Glycosylated hemoglobin is a combination of hemoglobin and glucose (or other sugars) in blood, a product of non-enzymatic catalytic reaction, which is used to evaluate the glycemic control of diabetes" Gold Standard "[3-4]. Studies have shown that the difference in blood glucose control before stroke (i.e., high glycated hemoglobin) is positively correlated with the occurrence of ischemic stroke[5-6], which can promote the formation of aortic atherosclerosis through a variety of mechanisms, is an independent risk factor in ischemic stroke and is more susceptible to post-cyclic ischemic stroke[7]. Objective To investigate the relationship between serum glycated hemoglobin level and post-circulating vascular disease severity, neurological function defect degree, disease progression and prognosis in patients with post-circulating cerebral infarction, and to investigate the role of glycosylated hemoglobin in the development of post-circulating cerebral infarction. This study is a retrospective study. From December 2014 to March 2016, 119 patients with acute post-circulation cerebral infarction were admitted to the neurology department of the People's Hospital of the People's Hospital of Hebei Province. Clinical manifestations of all patients were consistent with our country's 2010 issue of diagnostic criteria for acute ischemic stroke> and were confirmed by head nuclear magnetic examination. Detailed patient data: gender, age, history of hypertension, history of diabetes, history of coronary heart disease, smoking, blood pressure during admission, etc.; laboratory tests: triglyceride, cholesterol, low density lipoprotein, homotype cysteine, fasting blood glucose, Results of glycosylated hemoglobin; CTA (CT angiography) or total angiography (DSA); clinical data on admission and discharge of NIHSS scores, 30-day mRS scores, progress in disease progression, etc. The levels of glycated hemoglobin at admission were divided into normal group (6.5%, 60 cases), mildly elevated group (6.5% ~ 8.5%, 33 cases), severe raised group (65.80.5%, 26 cases), comparing the sex, age, past medical history, smoking, blood pressure and laboratory examination of three groups of patients. There was no difference in the incidence of diabetes mellitus, and the correlation between the level of glycated hemoglobin and the degree of stenosis of blood vessels, NIHSS score, mRS score of 30 days and progression of disease were analyzed. We found that there was no significant difference between the three groups (P <0.05), the history of diabetes mellitus, the newly diagnosed type of diabetes mellitus and the first fasting blood glucose in the hospital were statistically significant (P0.05). The proportion of stenosis in three groups was mild: 61.7%, 12.1%, 30.8%, moderate: 13.3%, 42.4%, 50. 0%, severe: 25.0%, 44.5%, 46.2%. With the increase of glycosylated hemoglobin level, the mild stenosis gradually decreased, and the moderately severe stenosis gradually increased (P0.01). T = 23.020); linear analysis showed a linear correlation between glycated hemoglobin level and degree of vascular stenosis (x2 = 20.053, P0.01, r = 0.9495). The level of glycosylated hemoglobin was lower than that of 8. 5% had a relatively small impact on NIHSS score, more than 8. 5% had a significant difference in NIHSS score (P0.05), NIHSS score and mRS score increased with the increase of HbA1c level. There was significant difference between the three groups (P 0.05). As the level of glycated hemoglobin increased, the proportion of disease progression in three groups was gradually increased (P0.05), and the level of glycated hemoglobin and progression of the disease were linearly related (x2 = 26,606, P0.01, r = 0.9431). Our results show that the level of glycated hemoglobin and the degree of vascular atherosclerotic stenosis in the patients with post-circulating cerebral infarction are closely related, and the higher the glycated hemoglobin level, the more severe the neurological deficit of the patient, the easier it progresses and the worse prognosis. Therefore, neurologist should strengthen the management of blood sugar in post-circulating cerebral infarction in clinical work, pay special attention to the control of glycosylated hemoglobin, strengthen health education, pay attention to the screening of cerebral vascular condition, thus preventing disease progression and improving prognosis.
【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3
本文編號(hào)：2311006
[Abstract]:In today's society, the incidence of ischemic cerebrovascular disease has been the first to threaten the health of the masses of the masses[1]. Along with the sustained progress of the global social aging process and the extension of population life, the incidence of ischemic cerebrovascular disease is also higher than that of innovation[2]. Cerebrovascular disease has the characteristics of four high (high incidence, high incidence rate, high disability rate, high recurrence rate) and gradual rejuvenation, which seriously affects the health of our people and has caused serious social and family burden. Therefore, the prevention and cure of ischemic cerebrovascular disease is an important issue to be solved by scientists and scientists at home and abroad. Type 2 diabetes is widely regarded as one of the important risk factors of ischemic cerebrovascular disease. Glycosylated hemoglobin is a combination of hemoglobin and glucose (or other sugars) in blood, a product of non-enzymatic catalytic reaction, which is used to evaluate the glycemic control of diabetes" Gold Standard "[3-4]. Studies have shown that the difference in blood glucose control before stroke (i.e., high glycated hemoglobin) is positively correlated with the occurrence of ischemic stroke[5-6], which can promote the formation of aortic atherosclerosis through a variety of mechanisms, is an independent risk factor in ischemic stroke and is more susceptible to post-cyclic ischemic stroke[7]. Objective To investigate the relationship between serum glycated hemoglobin level and post-circulating vascular disease severity, neurological function defect degree, disease progression and prognosis in patients with post-circulating cerebral infarction, and to investigate the role of glycosylated hemoglobin in the development of post-circulating cerebral infarction. This study is a retrospective study. From December 2014 to March 2016, 119 patients with acute post-circulation cerebral infarction were admitted to the neurology department of the People's Hospital of the People's Hospital of Hebei Province. Clinical manifestations of all patients were consistent with our country's 2010 issue of diagnostic criteria for acute ischemic stroke> and were confirmed by head nuclear magnetic examination. Detailed patient data: gender, age, history of hypertension, history of diabetes, history of coronary heart disease, smoking, blood pressure during admission, etc.; laboratory tests: triglyceride, cholesterol, low density lipoprotein, homotype cysteine, fasting blood glucose, Results of glycosylated hemoglobin; CTA (CT angiography) or total angiography (DSA); clinical data on admission and discharge of NIHSS scores, 30-day mRS scores, progress in disease progression, etc. The levels of glycated hemoglobin at admission were divided into normal group (6.5%, 60 cases), mildly elevated group (6.5% ~ 8.5%, 33 cases), severe raised group (65.80.5%, 26 cases), comparing the sex, age, past medical history, smoking, blood pressure and laboratory examination of three groups of patients. There was no difference in the incidence of diabetes mellitus, and the correlation between the level of glycated hemoglobin and the degree of stenosis of blood vessels, NIHSS score, mRS score of 30 days and progression of disease were analyzed. We found that there was no significant difference between the three groups (P <0.05), the history of diabetes mellitus, the newly diagnosed type of diabetes mellitus and the first fasting blood glucose in the hospital were statistically significant (P0.05). The proportion of stenosis in three groups was mild: 61.7%, 12.1%, 30.8%, moderate: 13.3%, 42.4%, 50. 0%, severe: 25.0%, 44.5%, 46.2%. With the increase of glycosylated hemoglobin level, the mild stenosis gradually decreased, and the moderately severe stenosis gradually increased (P0.01). T = 23.020); linear analysis showed a linear correlation between glycated hemoglobin level and degree of vascular stenosis (x2 = 20.053, P0.01, r = 0.9495). The level of glycosylated hemoglobin was lower than that of 8. 5% had a relatively small impact on NIHSS score, more than 8. 5% had a significant difference in NIHSS score (P0.05), NIHSS score and mRS score increased with the increase of HbA1c level. There was significant difference between the three groups (P 0.05). As the level of glycated hemoglobin increased, the proportion of disease progression in three groups was gradually increased (P0.05), and the level of glycated hemoglobin and progression of the disease were linearly related (x2 = 26,606, P0.01, r = 0.9431). Our results show that the level of glycated hemoglobin and the degree of vascular atherosclerotic stenosis in the patients with post-circulating cerebral infarction are closely related, and the higher the glycated hemoglobin level, the more severe the neurological deficit of the patient, the easier it progresses and the worse prognosis. Therefore, neurologist should strengthen the management of blood sugar in post-circulating cerebral infarction in clinical work, pay special attention to the control of glycosylated hemoglobin, strengthen health education, pay attention to the screening of cerebral vascular condition, thus preventing disease progression and improving prognosis.
【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3
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