血糖变异性对急性脑梗死合并糖尿病患者抑郁及预后的影响

Effect of glucose variability on depression and prognosis in patients with acute cerebral infarction combined with diabetes mellitus

目的血糖变异性(GV)对急性脑梗死合并糖尿病患者抑郁及预后的影响。方法回顾性分析2014年1月—2017年12月上海交通大学医学院附属新华医院崇明分院收治的82例急性脑梗死合并糖尿病患者的临床资料。以血糖的标准差(SD)作为GV指标,分为GV组(血糖水平SD≥1.4 mmol/L,n=49),对照组(血糖水平SD<1.4 mmol/L,n=33)。比较两组抑郁的发生情况和预后,采用多因素Logistic回归分析GV与PSD的相关性。结果发病后3个月,两组的汉密尔顿抑郁量表(HAMD)评分均明显升高,GV组HAMD评分明显高于对照组(P<0.05);多因素logistics回归分析显示,糖尿病病程、NIHSS评分及GV是急性脑梗死合并糖尿病患者预后的独立危险因素(P<0.05);两组发病后3个月NIHSS评分均明显降低,GV组NIHSS评分、mRS评分均明显高于对照组(P<0.05)。结论急性脑梗死合并糖尿病患者GV升高可导致抑郁的发生率增加和不良预后。

Objective To explore the effect of glucose variability(GV)on the depression and prognosis in the patients with acute cerebral infarction combined with diabetes mellitus.Methods Clinical data of 82 cases of acute cerebral infarction combined with diabetes mellitus in our hospital from January 2014 to December 2014 was analyzed retrospectively.With standard deviation(SD)of blood glucose as indicators of GV,patients was divided into GV group(SD of blood glucose≥1.4/L,n=49),and control group(SD of blood glucose<1.4/L,n=33).The occurrence of depression and prognosis was compared between two groups,and logistic regression was performed for the correlation between GV and prognosis.Results At 3 months after onset,the HAMD scores of two groups were significantly elevated,HAMD scores in GV group was obviously higher than that of control group(P<0.05).Multiple logistics regression analysis showed that diabetes duration,NIHSS score and GV were the independent risk factors for prognosis in patients with acute cerebral infarction and diabetes mellitus(P<0.05).The NIHSS scores in both group were significantly reduced at 3 months after onset,the NIHSS score,mRS score in GV group were significantly higher than those of control group(P<0.05).Conclusion Increased GV in acute cerebral infarction patients with diabetes mellitus can lead to an increased incidence of depression and poor prognosis.