后循环脑梗死患者同型半胱氨酸和血糖水平对预后的影响

Hcy and blood glucose levels on prognosis of patients with posterior circulation cerebral infarction

目的 探究后循环脑梗死患者同型半胱氨酸（Hcy）和血糖水平对预后的影响。方法 选取2011年5月至2013年5月本院收治的后循环脑梗死患者120例为研究对象,根据Hcy水平分为高Hcy组和低Hcy组,并根据美国国立卫生研究院卒中量表（NIHSS）、改良Ramkin量表评分评价预后。同时将120例患者分为高血糖组和低血糖组,比较其预后。结果 入院前两组患者NIHSS评分和Rankin评分均无显著差异（P〉0.05）,入院后3个月,高Hcy组中NIHSS〈4分,Rankin评分为0~2分患者例数与对照组比较差异显著（P〈0.05）。入院后3个月,低血糖组和高血糖组患者的临床症状比较差异具有显著性（P〈0.05）。将患者入院后3个月Rankin评分3~6分定义为预后不良,排除和矫正其他因素后发现,高Hcy血症是老年急性脑梗死预后不良的独立危险因素（OR=1.279;95%CI：0.867~3.457;P=0.049）;将患者入院后3个月昏睡和昏迷定义为预后不良,排除和矫正其他因素后发现,高血糖是老年急性脑梗死预后不良的独立危险因素（OR=1.574;95%CI：0.968~3.365;P=0.0219）。结论 Hcy及血糖水平对后循环脑梗死预后评价具有参考价值。

Objective To explore Hcy and blood glucose levels on prognosis of patients with posterior circulationcerebral infarction. Method From May 2011 to May 2013, a total of 120 patients with posterior circulation cerebral infarction in our hospital were chose. According to the Hcy levels, they were divided into high Hcy group and low Hcy group, and scores of standard according to the National Institutes of Health Stroke Scale （NIHSS） and modified Rankin scale score were evaluated. 120 patients were divided into hyperglycemia group and hypoglycemia group, and then compared their prognosis. Result NIHSS scores and Rankin scores of the two groups had no significant differences before admission, but 3 months after admission, patients in high Hcy group whose NIHSS 〈 4 points and Rankin score 0 - 2 points were clear difference with control group （P 〈 0.05）. Clinical symptoms of patients in hypoglycemia group and hyperglycemia group were significant difference （P 〈 0.05）. Defined Rankin score was 3 - 6 points as poor prognosis when 3 months after admission, and after excluding and correcting other factors, high Hcy levels was independent risk factor for the prognosis of elderly acute cerebral infarction （OR = 1.279; 95% CI： 0.867 - 3.457; P = 0.049）. We defined lethargy and coma when patients admitted to hospital for 3 months as a bad recovery of clinical symptoms, after excluding and correcting other factors, found that hyperglycemia was independent risk factors for the prognosis of elderly acute cerebral infarction （OR = 1.574; 95% CI： 0.968 - 3.365; P = 0.0219）. Conclusion Hcy and blood glucose levels are the key reasons on prognosis of posterior circulation cerebral infarction.