糖调节受损与颅内外动脉闭塞性病变的相关性

Relationship between impaired glucose regulation and intra- or extra-cranial artery occlusive disease

目的观察非糖尿病缺血性卒中患者糖调节受损(IGR)的发病率,并研究 IGR 与颅内外动脉粥样硬化性狭窄或闭塞(简称颅内外动脉闭塞性病变)的相关性。方法以非糖尿病且空腹血糖水平(FPG)<7.0 mmol/L 的缺血性卒中患者为研究对象(病程3周至半年)。依据经颅多普勒超声和头颅磁共振血管成像结果,将被研究者分为狭窄组(大血管病变组)与非狭窄组(小血管病变组);依据口服葡萄糖耐量试验(OGTF),5.6 mmol/L≤FPG<7.0 mmol/L 和(或)7.8 mmol/L≤OGTT2 h 血糖<11.1 mmol/L 者诊断为 IGR,OGTT 2 h 血糖≥11.1mmol/L 者诊断为糖尿病。结果 (1)160例缺血性卒中患者中 IGR 及糖尿病的患病率分别为35.6%(57/160)和21.8%(35/160);其中狭窄组为40.9%(45/110)和26.3%(29/110),非狭窄组为24.0%(12/50)和12.0%(6/50),两组比较前者明显高于后者(P=0.038,0.042);(2)Logistic 回归分析显示 OGTT 2 h 血糖、低高密度脂蛋白胆固醇及缺血性卒中家族史为颅内外动脉闭塞性病变的独立危险因素(OR=1.362、0.149、7.518,P=0.019、0.003、0.002)。结论经 OGTT 发现,IGR 在缺血性卒中患者中普遍存在,尤其伴有颅内外动脉闭塞性病变者更为常见。而 OGTT 2 h 血糖是 IGR 患者导致颅内外动脉闭塞性病变的独立危险因素。

Objective To observe the prevalence of impaired glucose regulation （IGR） in ischemic stroke patients with or without inter- or extra-cranial arteries occlusive disease, and to analyze the relationship of IGR with large arteries occlusive disease. Methods Ischemic stroke patients without diabetes history and with FPG 〈 7.0 mmol/L were enrolled and divided into large artery occlusive disease group and small artery disease group according to the results of transcranial Dopplor and magnetic resonance angiography. Then all patients underwent a standard 75 g oral glucose tolerance test （OGTI＇） after overnight fast. According to the result of OGTI＇, those with 5.6 mmol/L≤FPG 〈7.0 mmol/L and （or） 7. 8 mmol/L ≤OGTT 2 h glucose level 〈 11.1 mmol/L were diagnosed to have IGR and those with OGTT 2 h glucose level≥ 11.1 mmol/L were diagnosed as diabetes. Results （ 1 ） The prevalence of IGR and diabetes were 35.6% （57/160） and 21.8% （35/160） respectively in the cohort. They were more frequent in large arteries occlusive disease group than in small arteries disease group （40.9% and 26.3% vs 24. 0% and 12. 0%, P=0. 038,0. 042）. （2）Logistic regression analysis showed that OGTT 2 h glucose, low HDL-C and familiar history of ischemic stroke correlated with intra- or extra-cranial arteries occlusive disease independently （ OR = 1. 362, 0. 149, 7.518, respectively; P = 0. 019, 0. 003, 0. 002 respectively ） . Conclusions IGR is commonly seen in ischemic stroke patients, especially in those with large arteries occlusive disease. OGTT 2 h glucose is the independent risk factor of large arteries occlusive disease in IGR patients.