合并2型糖尿病的缺血性脑梗死复发危险因素研究

Study on Risk Factors of Ischemic Stroke Recurrence in Patients with Type 2 Diabetes Mellitus

目的分析合并2型糖尿病的急性缺血性脑卒中患者首次发生脑梗死与复发脑梗死的临床特点。方法采用Logistic回归分析,回归模型以脑梗死为因变量,年龄、性别、高血压病、糖尿病、三酰甘油(TG)、胆固醇、低密度脂蛋白(LDL-C)、高密度脂蛋白、纤维蛋白原、血小板聚集率、尿酸、同型半胱氨酸、颈动脉斑块及吸烟为自变量,分析缺血性脑卒中的危险因素。回顾性分析合并2型糖尿病的缺血性脑卒中首次发生脑梗死100例患者的临床资料,与复发性脑梗死100例患者进行对比分析。结果年龄、糖尿病、LDL-C、颈动脉斑块及吸烟是缺血性脑梗死的独立危险因素。合并糖尿病的缺血性脑卒中首次脑梗组年龄63.26岁±9.93岁,入院时收缩压、舒张压均高于复发脑梗死组,收缩压结果有统计学意义(P<0.05);首次脑梗组胆固醇、TG、LDL-C均高于复发组(P<0.05);复发脑梗组年龄66.35岁±9.51岁,纤维蛋白原、血小板聚集率均高于首发组(P<0.05)。颈动脉斑块性质分析,两组均以硬斑为主,结果无统计学意义。首发组入院及出院时NHISS评分均低于复发组(P<0.05)。合并糖尿病的急性缺血性脑卒中首发组以部分前循环梗死(PICA)比例最多,而复发组以腔隙性脑梗死(LACI)比例最多,结果有统计学意义。结论合并2型糖尿病的缺血性卒中,首次脑梗死组收缩压高,血脂明显异常,而复发脑梗组血液黏度升高;首次脑梗组以部分前循环梗死为主,复发脑梗组以腔隙性脑梗死为主,呈多灶病变;复发脑梗组患者预后差,遗留神经功能缺损较明显,住院时间延长,卒中相关性痴呆发生率高。

Objective To analyze the risk factors of ischemic stroke recurrence in patients with type 2 diabetes mellitus（T2DM）. Methods The risk factors of ischemic stroke were analyzed by using logistic regression analysis,and regression model of cerebral in farction was established, and following, age, sex, hypertension, diabetes, triglycerides, cholesterol, low density lipoprotein cholesterol （LDL C）, high density lipoprotein cholesterol （ HDL C）, fibrinogen, platelet aggregation, uric acid, homocysteine, carotid artery plaque and smoking as independent variables. Were collected from 100 T2DM patients with recurrent isehemic stroke（RIS） and 100 T2DM patients with first onset ischemic stroke（FIS）. Results Age,diabetes,LDL C, carotid artery plaque and smoking were in dependent risk factors for ischemic stroke. The admission systolic blood pressure（SBP）, diastolic blood pressure（DBP） in FIS group with age of 63.26±9.93 were higher than those in RIS group. There was obvious difference in SBP between two groups（P〈O. 05）. The triglycerides,cholesterol, I.DL C in FIS group were higher than those in RIS group. The fibrinogen and platelet aggregation in RIS group with age of 66.35± 9.51 were higher than those in FIS group（P〈0.05）. The mainly of carotid piaque was morphea in two groups. Admission and discharge NHISS score in FIS group was lower than that in RIS group. The main subtype of Oxfordshire Com munity Stroke Projeet（OCSP） classification was partial anterior circulation infarctions（PACI） in FIS group and lacunar infarctions （LACI） in RIS group. Conclusion T2DM patients with FIS had high SBP and markedly abnormal blood lipids while T2DM patients with RIS had elevated blood viscosity. The main subtype of OCSP classification was PACI in FIS group and LACI in RIS group. T2DM patients with RIS had poor prognosis,obvious neurological deficit,prolonged hospitalization,and high incidence of stroke re lated dementia.