急性缺血性脑卒中合并糖尿病人群的血糖变异性与神经功能恶化的相关性分析

Correlation between glycemic variability and neurological deterioration in patients with acute ischemic stroke and diabetes mellitus

目的探索急性缺血性脑卒中(acute ischemic stroke,AIS)合并糖尿病人群的血糖变异性与神经功能损害的相关性。方法选取AIS合并糖尿病患者125例,记录基线状态下一般临床资料,并分别于入院及出院时进行美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分,于出院1个月后随访进行改良Rankin量表(modified Rankin Scale,mRS)评分,评估患者卒中后神经功能变化与残障情况。根据NIHSS评分是否上升分为非恶化组(79例)和恶化组(46例),对比两组基线资料和血糖变异性参数。采用Logistic回归分析影响神经功能恶化的可能因素,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估血糖变异性指标对神经功能恶化的预测价值。结果两组基线临床资料相比差异无统计学意义,两组血糖变异性参数相比,葡萄糖目标范围内时间(time in range,TIR)、平均血糖波动幅度(mean amplitude of glycemic excursions,MAGE)、最大血糖波动幅度(largest amplitude of glycemic excursions,LAGE)差异均存在统计学意义(P<0.05)。二元Logistic回归分析显示,TIR(OR=0.937,P<0.001)、MAGE(OR=1.360,P=0.024)、LAGE(OR=1.364,P=0.015)是NIHSS评分恶化的危险因素。有序多因素Logistic回归分析提示,入院48 h血糖平均值(OR=1.208,P=0.033)、MAGE(OR=1.206,P=0.040)以及入院空腹血糖(OR=1.182,P=0.016)是影响mRS评分的危险因素。ROC曲线提示TIR预测发生恶化的曲线下面积(area under the curve,AUC)为0.781(95%CI:0.699-0.862,P<0.001),灵敏度为82.6%,特异度为60.8%,最佳截断值为41.3%。结论以TIR等为代表的血糖变异性指标可能是提示AIS合并糖尿病患者神经功能恶化的相关因素。

Objective To explore the correlation between glycemic variability and neurological impairment in patients with acute ischemic stroke(AIS)complicated with diabetes mellitus.Methods A total of 125 patients with AIS and diabetes mellitus were selected.The general clinical data at baseline were recorded,and the National Institutes of Health Stroke Scale(NIHSS)was scored at admission and discharge respectively,and the modified Rankin Scale(mRS)score was recorded 1 month after discharge to evaluate neurological changes and disability after stroke.According to whether the NIHSS score worsened or not,the patients were divided into a non-deterioration group and a deterioration group,and the baseline data and glycemic variability parameters were compared between the two groups.Logistic regression was used to analyze the possible factors affecting neurological deterioration,and the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of blood glucose variability indicators for neurological deterioration.Results There was no statistical difference in baseline clinical data between the two groups,but a statistical differences in blood glucose variability parameters with mean amplitude of glycemic excursions(MAGE)and largest amplitude of glycemic excursions(LAGE)(P<0.05).Binary Logistic regression analysis showed that time in range(TIR)(OR=0.937,P<0.001),MAGE(OR=1.360,P=0.024),and LAGE(OR=1.364,P=0.015)were the risk factors for worsening NIHSS score.Ordinal multivariate Logistic regression analysis showed that MEAN(OR=1.208,P=0.033),MAGE(OR=1.206,P=0.040)and admission fasting blood glucose(OR=1.182,P=0.016)were the risk factors affecting the mRS score.The ROC curve showed that the area under the curve(AUC)of TIR for predicting deterioration was 0.781(95%CI:0.699-0.862,P<0.001),the sensitivity was 82.6%,the specificity was 60.8%,and the best cut-off value was 41.3%.Conclusion The glycemic variability indicators represented by TIR and others are related factors that may indicate the deterioration of neurological function in patients with AIS and diabetes mellitus.