脑梗死急性期糖尿病及高血糖对其神经功能恢复和预后影响的Meta分析

Effects of diabetes mellitus and hyperglycemia on prognosis and neural functional recovery in patients with acute cerebral infarction:a Metaanalysis

目的:应用Meta分析方法认识糖尿病和高血糖对急性脑梗死患者预后的影响。方法:实验于2004-10在暨南大学附属第一医院进行,应用计算机检索中国期刊网全文数据库(CNKI,1994/2004),主题词包括糖尿病、高血糖和脑梗死。文献纳入标准是:论文内容包含有糖尿病及/或(应激性)高血糖对急性脑梗死患者预后影响的对照研究;治疗效果以量表的量化性质反映出来,且为计数资料。应用Meta分析方法对检索出的符合要求的12项研究进行同质性检验和合并效应量的检验。结果:①同质性检验:糖尿病对急性脑梗死患者预后影响的9项对照研究及高血糖对急性脑梗死患者预后影响的7项对照研究均是同质的,P均>0.05。②合并效应量的检验:急性脑梗死正常血糖组的神经功能恢复显著优于糖尿病组(OR合并=4.08,95%CI:3.06～5.43)及高血糖组(OR合并=2.96,95%CI:2.11～4.14),而糖尿病组及高血糖组的死亡率则显著高于正常血糖组(OR合并分别为3.72和5.82,95%CI分别为2.22～6.22和3.77～8.99)。糖尿病及高血糖组发生消化道出血、肺部感染、心律失常和肾功能衰竭等并发症的比率分别是正常血糖组的1.81,4.17,5.95和6.15倍。结论:血糖升高可加重脑缺血损害,糖尿病和高血糖是急性脑梗死神经功能恢复不好预后不良的重要危险因素之一。

AIM:To study the effects of diabetes mellitus and hyperglycemia on the prognosis of patients with acute cerebral infarction by using Metaanalysis. METHODS:The experiment was performed in the First Affiliated Hospital of Jinan University in October 2004.Using the key terms “diabetes mellitus,hyperglycemia,cerebral infarction',we searched the Chinese journals fulltext database from 1994 to 2004.The inclusive criteria were controlled trials related to the effect of diabetes mellitus or excitability hyperglycema on the prognosis of patients with acute cerebral infarction;the therapeutic efficacy was showed by measuring scale with enumeration data.Metaanalysis was used to detect homogeneity test and combined test in 12 studies metting the criteria were. RESULTS:①Homogeneity test showed that 9 articles related to the effect of diabetes mellitus on the prognosis of patients with acute cerebral infarction and 7 related to the effect of hyperglycemia were homogeneous(P >0.05).②Combined test showed that the neural function in normal blood glucose group recovered significantly better than that in diabetes mellitus group(OR=4.08,95%CI: 3.06-5.43) and hyperglycemia group(OR=2.96,95%CI:2.11-4.14).The mortality in diabetes mellitus group and hyperglycemia group was significantly higher than that in normal blood glucose group,respectively(OR=3.72,5.82,95%CI:2.22-6.22,3.77-8.99,respectively).The ratio of complications such as gastrointestinal haemorrhage,pulmonary infection,arrhythmia and renal failure in diabetes mellitus and hyperglycemia groups was respectively 1.81,4.17,5.95 and 6.15 times as much as that in normal blood glucose group. CONCLUSION:Advanced blood glucose may aggravate cerebral ischemic lesions.Diabetes mellitus and hyperglycemia are one of the risk factors for poor prognosis in patients with acute cerebral infarction.