糖耐量异常的急性前循环脑梗死患者左室舒张功能的改变及其对预后的影响

Changes of Left Ventricular Diastolic Function in Patients of Acute Cerebral Infarction with Impaired Glucose Tolerance and Its Influence on Prognosis

目的 探讨急性前循环脑梗死合并糖耐量异常患者的左室舒张功能的改变及其对卒中预后的影响.方法 急性脑梗死患者106例,均于脑梗死2周后行75g口服葡萄糖耐量试验（oral glucose tolerance test,OGTT）.按OGTT结果分为糖耐量正常组（normal glucose tolerance,NGT）33例、糖耐量异常组（impaired glucose tolerance,IGT）,35例和糖尿病组（diabetes mellitus,DM）38例.于入院后次日早晨空腹查糖化血红蛋白、心肌酶谱、血脂、肝功,肾功等生化指标.发病两周后行心脏超声心动图检查,测量左室射血分数（left ventricular ejection fraction,LVEF）、E峰、A峰等心功能指标.于发病90 d进行改良的Rankin评分（modified Rankin Scale,mRS）作为评估预后的指标.结果 （1）E/A＜1在NGT,IGT和DM组所占的比率分别是63.6%、85.7%、84.2%.IGT及DM组E/A＜1的比率与NGT组比较有统计学意义（χ^2=4.42,P=0.036 χ^2=3.95,P=0.047）.（2）卒中后90 d mRS与E/A（r=-0.452,P=0.000）、每博输出量（stroke volume,SV）（r=-0.228,P=0.020）、左室射血分数（left ventricular ejection francOon,LVEF）（r=-0.328,P=0.001）,左室短轴缩短率（franctional shorting,FS）（r=-0.301,P=0.002）、E峰（r=-0.321,P=0.001）呈负相关.结论 急性脑梗死患者左室舒张功能的异常与血糖水平密切相关,伴有IGT的急性脑梗死患者出现了左室舒张功能的下降,左室舒张功能的下降影响了伴IGT的急性脑梗死患者的预后.

Objective To observe the changes of left ventricular diastolic function in patients of acute cerebral infarction with impaired glucose tolerance and its impact on stroke prognosis. Methods One hundred and six patients with acute cerebral infarction were undergone 75g oral glucose tolerance test （OGTT） at two weeks after infarction. According to the results of OGTT, the patients were divided into normal glucose tolerance group （NGT, 33）, impaired glucose tolerance group （IGT, 35） and diabetes mellitus group （DM, 38）. Glycosylated hemoglobin, myocardial enzymes, blood lipids, liver function, kidney function and other biochemical parameters were tested on the morning after admission in the last state. All patients were undergone echocardiography investigation to measure left ventricular ejection fraction, E velocity, A velocity and other indicators of cardiac function. Ninety days after stroke, the patients will be followed up using modified Rankin Scale （mRS）. Results （1） The E/A ratio〈1 reflects impaired left ventricular diastolic function. The proportion of subjects with an E/A ratio〈1 was 63.6%, 85.37% and 84.2% in NGT, IGT and DM groups differently. The E/A ratio〈1 in IGT group and DM group were higher than that in NGT group, the difference were statistically significant （χ^2-4.42, P=0.036; χ^2-3.95, P-0.047）. （2） 90 days after stroke, the level of mRS was negatively related with E/A ratio （r=-0.452, P=0.000）, stroke volume （r=-0.228, P=0.020）, left ventricular ejection fraction （r=-0.328, P=0.001）, fractional shorting （r=-0.301, P=0.002） and E velocity （r=-0.321, P=0.001）. Conclusion Impaired left ventricular diastolic function is closely related with the level of blood glucose in patients with acute cerebral infarction. In the stage of IGT, it has emerged decreased left ventricular diastolic function and affected nerve function recovery after cerebral infarction.