无糖尿病史急性缺血性脑卒中患者入院早期动态血糖监测

Continuous glucose monitoring during early phase of acute ischemic stroke in patients without diabetes mellitus history

目的采用动态血糖监测方法监测无糖尿病史急性缺血性脑卒中患者早期血糖变化,从而为临床提供更详细的血糖代谢信息及预后评估。方法对连续91例急性缺血性脑卒中患者采用动态血糖监测方法观察早期血糖波动情况,根据血糖代谢紊乱程度依次分为血糖正常组(31例)、一过性血糖升高组(20例)和持续性血糖升高组(40例)。比较3组患者一般情况及平均血糖、血糖水平标准差、最大血糖波动幅度、平均血糖波动幅度和日间血糖平均绝对差及相关血液生化指标差异,同时比较治疗后24h、7d、14d神经缺损评分。结果持续性血糖升高组患者男性比例低于其他两组(P<0.05),有陈旧性脑梗死、高血压史的病例比例高于其他两组(P<0.05);平均血糖、血糖水平标准差、最大血糖波动幅度、平均血糖波动幅度和日间血糖平均绝对差高于其他两组(P<0.01);总胆固醇、三酰甘油、低密度脂蛋白胆固醇、糖化血红蛋白、C反应蛋白、同型半胱氨酸水平高于其他两组(P<0.01);治疗后7d及14d神经缺损评分高于其他两组(P<0.05,P<0.01)。结论动态血糖监测能准确反映急性缺血性脑卒中患者入院早期血糖代谢情况,可指导进一步治疗及预后评估。

Objective To continuously monitor the glucose level during the early phase of acute ischemic stroke （AIS） in patients without diabetes mellitus history, so as to provide evidences for detailed blood glucose information and prognostic evaluation. Methods Ninety-one consecutive non-diabetic AIS patients received continuous glucose monitoring and were divided into normoglycemia （n=20）, transient hyperglycemia （n=31）, and persistent hyperglycemia （n=40） groups. The general data, blood glucose fluctuation parameters and biochemical indices were compared between the three groups. The National Institutes of Health （NIH） Stroke Scale （NIHSS） scores were also compared between the three groups at 24 h, 7 d, and 14 d after treatment. Results The ratio of male patients and the ratio of cerebral infarction history and hypertension history in the persistent hyperglycemia group were significantly lower than those in the other two groups （P〈0.05）. Compared with the other two groups, the persistent hyperglycemia group had significantly higher mean blood glucose, standard deviation of blood glucose, largest amplitude of glycemia excursion, mean amplitude of glycemia excursion, and absolute mean of daily differences （all P〈0.01）. The levels of total cholesterol, triglyceride, low-density lipoprotein cholesterol, HbA1c, C reactive protein, and homocysteine in the persistent hyperglycemia group were significantly higher than those in the other two groups （P〈0.01）. The NIHSS scores of the persistent hyperglycemia group were significantly higher than those of other groups at 7 d and 14 d after treatment （P〈0.05,P〈0.01）. Conclusion Continuous glucose monitoring can accurately reveal the blood glucose metabolism during the early phase of AIS, contributing the following treatment and prognosis prediction.