重症脑梗死患者发生早期低血糖的危险因素及预后分析

Research on risk factors for early hypoglycemia and on its relationship with prognosis of patients with cerebral infarction

目的探讨重症脯梗死患者发生早期低血糖的危险因素，分析低血糖程度与脯梗死患者病情危重程度及预后的关系。方法我院伸经重症监护病房收治的273例脑梗死患者，以血糖水平分为正常血糖组、轻度低血糖组、重度低血糖组，比较3组患者的生化指标、美国同立卫生研究院卒中量表（NHISS）评分、痫死率。按照预后分为死亡组及存活组，比较两组的NHISS评分和血糖浓度及低血糖的发生率。Pearson直线相关分析低血糖水平与NHISS评分的关系，Spearman等级相关分析低血糖严重程度与病死率的关系。结果重度低血糖组患者的乳酸（6．3±2．8）mmol／L、肌酐（268．7±63．9）mmol／L、尿素（13．8±3．7）mmol／L、白蛋白（25．6±4.9）g／L、丙氨酸氨基转移酶（150±19．7）U／L、NHISS评分（22．3±9．2）分、病死率（38．1％）均明显高于轻度低血糖组和正常血糖组[乳酸：（4．7±2．3）mmol／L、（3．3±1.5）mmol／L，肌酐：（134．8±51．3）mmol／L、（78．7±40．8）mmol／L,尿素：（7．9±4．2）mmol／L、（7．7±3．3）mmol／L，白蛋白：（36．9±3．8）g／L、（35．6±4．3）g／L，丙氨酸氨基转移酶：（85．8±18．3）U／L、（46．3±13．8）U／L，NHISS评分：（14．6±5．9）分、（10．5±5．4）分，病死率：20．8％、11．0％，均P〈0．01]。低血糖水平与NHISS评分呈负相关（r=0．45，P〈0．0,5），低血糖严重程度与病死率呈正相关（r=-0.11，P〈0．05）。对影响血糖的危险因素进行多元Logistic回归分析，结果显示肌酐、丙氨酸氨基转移酶指标进入回归方程（均P〈0．05）。结论重症脑梗死患者发生早期低血糖与肝、肾功能不全密切相关，合并严重的低血糖常预示着预后不良。

Objective To investigate the risk factors for early hypoglycemia and its relationship with prognosis of patients with cerebral infarction. Methods A total of 273 patients with cerebral infarction were divided into tire normal blood glucose（NBG） and severe hypoglycemia（SHG）and mild hypoglycemia（ MHG） groups in our hospital Biochemical indicators, tile National Institute of Heahh stroke scale（NIHSS）and mortality were compared between the three groups. According to prognosis, patients were divided into death group and survival group. The NIHSS score, blood glucose concentration and incidence of hypoglycemia were compared between death and survival groups. Pearson relationship between hypoglycemia and NiHSS score, and spearman rank correlation between hypoglycemia severity and mortality were analyzed. Results I.evels of lactic acid （6.3 2.8）mmol/L,creatinine（268.7±63.9） mmol/L, urea nitrogen（ 13.8±3.7） mmol/L, albumin（25.6±4.9）g/L,alanine aminotransferase（150±19.7） U/L, NIHSS（22.3±9.2） scores, and mortality rates （38.1%）were higher in severe hypoglycemia group than in both NBG group and severe hypoglycemia group[（ lactic acid：4.7±2.3 mmol/L and 3.3±1.5 mmol/L） , （crcatinine 134.8±51.3 mmol/l, and 78.7±40.8 mmol/L）, （urea nitrogen 7.9±4.2 mmol/L and 7.7±3.3 mmol/L） ,（albumin 36.9±3.8 g/L and 35.6±4.3g/L）,（alanine aminotransferase 85.8±18.3U/I. and 46.3±13.8U/L）, （NHISS 14.6±5.9 scores and 10.5±5.4 scores）and（mortality rates 20.8%,11.0%）]（all P〈0.0.01）.There was a negative correlation between hypoglycemia and NIHSS score （r=-0.45, P〈0.05 ）. There was a positive correlation between hypoglycemic severity and mortality （r = 0.41, P〈 0.05 ）. Multiple Logistic regression showed that creatinine and alanine aminotransferase were correlated with hypoglycemia and prognosis of patients with cerebral infarction（both P〈0.05）. Condusions Early hypoglycemia in patients with severe cerebral infarction is closely correlated with the liver and kidney insufficiency, and a severe cerebral infarction combined with hypoglycemia often indicate a poor prognosis.