2型糖尿病病人并发缺血性脑卒中急性期血糖波动趋势及影响因素分析

Analysis of the tendency of blood glucose fluctuation and its influencing factors in type 2 diabetic patients with acute ischemic stroke

目的探索2型糖尿病(T2DM)病人并发缺血性脑卒中(IS)急性期血糖水平及影响因素。方法收集江苏大学附属医院2017年1-10月175例T2DM并发IS病人入院后测定的糖化血红蛋白(HbA1c)、空腹血糖、总蛋白、白蛋白、血红蛋白、三酰甘油、总胆固醇、吞咽功能等级、营养支持方式、末梢血糖测定值等资料进行回顾性分析。日间血糖波动采用空腹血糖变异系数(CV?FPG)评估,日内血糖波动采用血糖水平的标准差(SDBG),餐后血糖波动采用餐后血糖波动幅度(PPGE)评估,描绘病人急性期血糖波动曲线,并对其进行单因素和多元线性回归分析。结果入院后7d,病人CV-FPG为(0.20±0.10),SDBG为(2.61±0.81)mmol/L,PPGE为(2.92±0.99)mmol/L。SDBG随入院时间的推移呈先快后慢的下降趋势。高HbA1c、低白蛋白和吞咽障碍是CV-FPG增高的独立影响因素,空腹血糖与SDBG呈正相关,经口进食的营养支持方式是PPGE增高的独立影响因素(均P<0.05)。结论T2DM病人并发缺血性脑卒中急性期的血糖波动幅度随时间的推移呈倒数式减小,HbA1c、空腹血糖、白蛋白、吞咽功能和营养支持方式是其主要影响因素。

Objective To investigate the trend and influencing factors of glycemic variability(GV)in type 2 diabetes mellitus pa tients complicated with acute ischemic stroke.Methods A total of 175 T2DM with IS patients were collected for retrospective anal ysis of HbA1c,FPG,Alb,Hb,TG,TC,swallowing function,nutritional support way and peripheral blood glucose measurements after admission.The day to day GV was evaluated by coefficient of variability fasting plasma glucose(CV FPG),within day GV by stan dard deviation of blood glucose(SDBG)and postprandial glucose excursion by postprandial glucose excursion(PPGE).The GV curve was described and analyzed using single factor analysis and multiple regression analysis.Results On 7 days,CV FPG was(0.20±0.10),SDBG was(2.61±0.81)mmol/L and PPGE was(2.92±0.99)mmol/L.The SDBG changed dynamically with time demon strating a trend that went first fast and slow later.High HbA1c,low Alb and swallowing disorders were independent related factors for increase of CV FPG.FPG was positively correlated with SDBG.The nutritional support mode through mouth was an independent factor affecting the increase of PPGE(P<0.05).Conclusion T2DM patients have the GV which decreased inversely with time in the acute phase of ischemic stroke,and HbA1c,FPG,Alb,swallowing function and nutritional support mode the main determinants that affect such fluctuations.