血清糖化血红蛋白水平与急性脑梗死早期神经功能恶化的相关性分析

Correlation analysis of serum glycated hemoglobin A1c level and early neurological deterioration of acute cerebral infarction

目的探讨血清糖化血红蛋白（Hb A1c）水平对急性脑梗死患者早期神经功能恶化（END）的预测价值。方法回顾性连续纳入2014年6月至2016年1月于宿迁市人民医院神经内科住院,且起病至入院时间间隔〈3 d的缺血性卒中急性期患者。入院当天采用美国国立卫生研究院卒中量表（NIHSS）对所有患者行神经功能缺损情况评估,入院7 d内多次对患者神经功能缺损症状进行复评,任意1次评分较入院时增加≥2分定义为END。对符合入组和排除标准的226例患者按急性脑梗死后是否发生END分为END组50例（22.1%）和非END组176例（77.9%）。采用单因素分析组间各因素差异,多因素Logistic回归分析血清Hb A1c水平与END的相关性。结果与非END组相比,END组患者年龄、糖尿病患病率、NIHSS评分、超敏C反应蛋白水平、ASPECT评分0-7分患者比例及血清Hb Alc水平均明显升高,差异有统计学意义（均P〈0.05）。Logistic回归分析结果示,超敏C反应蛋白和血清Hb A1c水平升高是急性脑梗死END的独立危险因素（OR值分别为1.048、1.809,95%CI分别为1.008-1.089、1.429-2.292;P值分别为0.018、0.002）。结论血清Hb A1c水平升高是急性脑梗死END的危险因素,对END具有一定预测价值。

Objective To investigate the predictive value of serum glycated hemoglobin Ale （HbA1c） level and early neurological deterioration （END） in patients with acute cerebral infarction. Methods From June 2014 to January 2016,the consecutive patients with acute ischemic stroke （interval time from onset to admission 〈 3 days） admitted to the Department of Neurology,Suqian People＇s Hospital were enrolled retrospectively. The neurological deficits of all patients were evaluated on the day of admission with the National Institutes of Health Stroke Scale （NIHSS）. The symptoms of neurological deficits in patients were evaluated repeatedly for all patients within 7 days after admission. Any score increased ≥ 2 compared with before admission was defined as END. The 226 patients met the inclusion and exclusion criteria were enrolled,and they were divided into either an END group （n = 50,22. 1% ） or a non-END group （n = 176,77.9% ） according to whether END occurred after acute cerebral infarction. Univariate analysis was used to analyze the differences between the 2 groups. Multivariable Logistic regression analysis was used to analyze the correlation between the HbA1 c level and END. Results Compared with the non- END group, there were significant differences in the age, prevalence of diabetes, NIHSS score, hypersensitive C-reactive protein level, rate of ASPECT score 0-7, and serum HbAlc level in the patients of the END group （ all P 〈 0.05 ）. The results of logistic regression analysis showed that the elevated hypersensitive C-reactionprotein and serum HbAlc levels were the independent risk factem for END of acute cerebral infarction （ OR,1. 048 and 1. 809 respectively,95% CI 1.008 -1. 089 and 1. 429 -2. 292 respectively ;P =0. 018 and 0.002 respectively）. Conclusion The increased serum HbA1c level is an independent risk factor for END of acute cerebral infarction. It has certain predictive value for END.