急性缺血性脑卒中患者新诊断的糖代谢异常的影响因素

Influence factors of new diagnosed abnormal glucose metabolism in patients with acute cerebral ischemic strokes

目的：研究急性缺血性脑卒中患者新诊断的糖代谢异常的影响因素。方法120例无糖尿病史的急性缺血性脑卒中患者按类肝素药物治疗急性缺血性脑卒中试验（ TOAST）亚型分类标准，分为大动脉粥样硬化性卒中（ LAA）、小动脉闭塞性卒中（ SAO）、心源性栓塞（ CES）和不明原因的缺血性卒中（ UND）亚组。在发病1周后，给患者进行葡萄糖耐量试验（ OGTT），出现糖调节受损（ IGR）或糖尿病为糖代谢异常。并对有关指标进行比较，以及行多因素Logistic分析。结果本组患者中糖代谢正常68例（56．7％），糖代谢异常52例（43．3％），其中IGR 38例（31．7％）、糖尿病14例（11．7％）。 LAA亚组糖代谢异常的比率（63．8％）明显高于其他亚组（27．3％～31．4％）（均P＜0.05）；其他亚组间的差异无统计学意义。糖代谢异常组的年龄及高脂血症和有糖尿病家族史的比率明显高于糖代谢正常组（ P＜0.05～0．01）。多因素Logistic分析示，高脂血症（ OR＝1．671，95％CI：1．208～2．311，P＝0.012）、糖尿病家族史（ OR＝1．421，95％CI：1．114～1．813， P＝0.042）和LAA型（OR＝2．825，95％CI：1．706-4．674，P＝0.023）是缺血性脑卒中新诊断糖代谢异常的独立危险因素。结论急性缺血性脑卒中患者的新诊断糖代谢异常率较高，高脂血症、糖尿病家族史及LAA亚型是其独立危险因素。

Objective To investigate the influnce factors of new diagnosed abnormal glucose metabolism in patients with acute cerebral ischemic stroke .Methods One hundres and twenty stroke patients without history of diabetes were divide into large artery atherosclerotic stroke （LAA）, small arterial occlusive stroke（SAO）, cardiac embolic stroke（CES）, undeterminined etiology stroke （UND） subgroups according to the Trial of ORG 10172 in Acute Stroke Treatment（TOAST） classfication.The patients were tested oral glucose tolerance test （OGTT） one week later after stroke. The impaired glucose regulation （ IGR ） and diabetes patients called the abnormal glucose metabolism group ,compare related indicators and make multivariate Logistic regression analysis .Results There were 68 patients（56.7%） with normal metabolism, 52 patients （43.3%） with abnormal glucose metabolism.Among them, 38 cases were IGR （31.7%）, 14 cases were diabetes （11.7%）.The rate of abnormality of impaired glucose metabolism in LAA subgroup（63.8%） was significantly higher than the other subgroups （27.3%-31.4%）（all P〈0.05）.There was no statistically significant difference between the other subgroups .Compared with normal glucose metabolism group, age, the rate of hyperlipidemian and family history of diabetes were significant higher in abnormal glucose metabolism group （P〈0.05 -0.01）.Multivariate logistic regression analysis showed that hyperlipidemia （ OR=1.671,95%CI：1.208 -2.311,P=0.012）, family history of diabetes （OR =1.421,95%CI：1.114 -1.813,P=0.042） and LAA（OR=2.825,95%CI：1.706-4.674,P=0.023） were independent risk factors of new diagnosed abnormal glucose metabolism in ischemic stroke .Conclusion There is a high prevalence of new diagnosed abnormal glucose metabolism in ischemic stroke .Hyperlipidemia , family history of diabetes and LAA are independent risk factors of it .