2型糖尿病合并急性脑梗死的临床研究

Clinical study of type-2 diabetes mellitus complicated with acute cerebral infarction

目的探讨2型糖尿病合并急性脑梗死的临床特点。方法选择住院的糖尿病合并急性脑梗死患者(糖尿病组)150例,另随机选择同期的非糖尿病合并急性脑梗死患者(对照组)1 50例。对2组患者年龄、性别、空腹血糖、糖化血红蛋白、血脂、临床表现、脑梗死部位、病情轻重程度、并发症、临床疗效及预后进行比较。结果与对照组比较,糖尿病组患者年龄、男性比例明显降低,空腹血糖、糖化血红蛋白、TC、TG、LDL-C、偏盲、眩晕、复视、共济失调明显升高(P<0.05,P<0.01);糖尿病组患者后循环梗死多见,占40.0%,对照组患者部分前循环梗死多见,占45.3%(P<0.01),空腹血糖<7.0 mmol/L、7.0～11.1 mmol/L、>11.1 mmol/L患者的美国国立卫生院脑卒中量表评分分别为(5.12±1.21)分、(7.94±2.13)分、(11.90±2.35)分(P<0.01)。结论糖尿病和脑卒中的发病与年龄、性别密切相关;糖尿病合并急性脑梗死临床症状轻重程度与入院时血糖水平密切相关;糖尿病合并急性脑梗死后循环梗死多见,且并发症多,临床疗效及预后差。

Objective To investigate the clinical characteristics of type-2 diabetes mellitus complicated with acute cerebral infarction. Methods 150 patients with type-2 diabetes mellitus complicated with acute cerebral infarction in Anzhen Hospital from 2008 to 2009 were investigated as the diabetes group. 150 cases with acute cerebral infarction without type-2 diabetes mellitus were enrolled as the control group. Age, sex, fasting blood glucose （FBG）, glycosylated hemoglobin （HbA1c）, TG, TC, HDL-C, LDL-C, clinical manifestation, position of cerebral infarction, complications, efficacy of treatment and prognosis were compared between the two groups. Results Compared with the control group, age and proportion of male patients were significantly lower, hemianopia, vertigo, diplopia, ataxia, FBG, HbA1 c, TG, TC, LDL-C were significantly higher in diabetes group （P 〈 0.05, P〈0.01）. Main position of cerebral infarction was posterior circulation in diabetes group, accounting for 40.0 %, while main position of cerebral infarction was partial anterior circulation in control group, accounting for 45. 3% （P 〈 0. 01）. In diabetes group, the NIHSS scores of the patients with FBG〈7.0 mmol/L,7.0-11.1 mmol/L and〉11. 1 mmol/L were 5.12±1.21,7.94±2.13 and 11.90±2.35 （P〈0.01）. Conclusion Diabetes mellitus and stroke were correlated with age and sex. Severity of clinical symptoms was correlated with the blood glucose level on admission in type-2 diabetes mellitus complicated with acute cerebral infarction. Main type of cerebral infarction was posterior circulation infarction in diabetes group. Incidence of complications in the diabetes group was significantly higher than that in the control group. Therapeutic efficacy and prognosis were worse in diabetes group.