急性前循环缺血性脑卒中合并糖尿病患者63例血糖漂移与美国国立卫生研究院卒中量表评分的关联性分析

Correlation between blood glucose concentration drift and NIHSS score in 63 patients with acute anterior circulation ischemic stroke and diabetes

目的分析急性前循环缺血性脑卒中(AIS)合并糖尿病患者血糖漂移与其美国国立卫生研究院卒中量表(NIHSS)评分的关联性。方法选取2018年3月至2021年2月我院63例前循环AIS合并糖尿病患者(观察组),并选取同期糖尿病患者57例(对照1组)、健康体检者71名(对照2组),使用动态血糖监测系统监测其血糖波动水平[空腹血糖(FBG)、平均血糖、空腹胰岛素(Fins)、血糖波动频数、最大血糖波动幅度(LAGE)、平均血糖波动幅度(MAGE)],并比较降糖治疗前及治疗1个月后观察组患者NIHSS评分,同时了解血糖漂移与NIHSS评分的关联性。结果3组间血糖波动频数对比,差异无统计学意义(P>0.05),而3组间FBG、平均血糖、Fins、LAGE、MAGE对比,差异具有统计学意义,同时,观察组FBG、平均血糖、LAGE、MAGE>对照1组>对照2组(P<0.05);观察组患者治疗前、治疗1个月后NIHSS评分对比,差异具有统计学意义(P<0.05);且相关性分析发现,观察组患者血糖漂移与治疗前、治疗1个月后NIHSS评分具有相关性(P<0.05),其中,MAGE、LAGE均与治疗前、治疗1个月后NIHSS评分呈正相关(P<0.05)。结论前循环AIS合并糖尿病患者血糖漂移与NIHSS评分紧密相关,因此,临床在治疗过程中不仅要关注血糖控制情况,还应重视控制血糖波动幅度。

Objective To investigate the correlation between blood glucose concentration drift and the National Institutes of Health Stroke Scale(NIHSS)score in patients concomitantly with acute anterior circulation ischemic stroke(AIS)and diabetes.Methods Sixty-three AIS patients with diabetes in our hospital between March 2018 and February 2021 were included as the study group,57 patients with diabetes alone and 71 healthy checkup subjects during the same period were enrolled as the control groups 1 and 2.Using a continuous glucose monitoring system,the subjects were monitored for fluctuations in blood glucose[fasting blood glucose(FBG),mean blood glucose,fasting insulin(Fins),frequency of blood glucose fluctuations,largest amplitude of glycemic excursion(LAGE),and mean amplitude of glycemic excursion(MAGE)].The NIHSS scores in the study group be-fore and at one month after glucose-lowering treatment were compared.The correlation between blood glucose concentration drift and NIHSS scores was analyzed.Results Across the three groups,there was no significant difference in frequency of blood glucose fluctuations(P>0.05),but the values of FBG,mean blood glucose,Fins,LAGE,and MAGE differed statistically.The values of FBG,mean blood glucose,LAGE,and MAGE were greatest in the study group,followed by the control group 1 and control group 2(P<0.05).In the study group,the NIHSS scores at one month after therapy differed statistically from baseline(P<0.05).Correlation analysis showed that the blood glucose concentration drift in patients of the study group significantly correlated with NIHSS scores before and at one month after treatment(P<0.05).In particular,the values of MAGE and LAGE were positively correlated with NIHSS scores either at baseline or at one month after treatment(P<0.05).Conclusion The blood glucose concentration drift in patients with acute AIS and diabetes is closely related to the NIHSS score.During the treat-ment,clinical attention should therefore focus not only on the blood glucose control,but also on handling the fluc-tuations of blood glucose.