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1、·406·《临床荟萃》2009年3月5日第24卷第5期ClinicalFocus,March5,2009,Vol24,No.5·论著·高血糖对急性缺血性脑卒中亚型预后的影响张平,李满连(永州市人民医院神经内科,湖南永州425000)摘要:目的探讨入院时高血糖对腔隙性脑梗死和非腔隙性脑梗死预后的影响是否一致。方法采用前瞻性队列研究方法,共有248例缺血性卒中患者纳入试验,研究卒中发作8小时内血糖浓度与神经功能预后的关系。有益的终点定义为3个月后改良Rankin量表评分≤2分;根据牛津郡社区卒中计划(O
2、SCP)进行临床分型,并经头颅CT证实为腔隙性脑梗死(n=62)和非腔隙性脑梗死(n=186);高血糖定义为血糖≥8mmol/L。结果非腔隙性脑梗死组入院时血糖水平、高血压史和意识改变高于腔隙性脑梗死组,差异有统计学意义(P<0.01或<0.05)。单因素分析显示,在腔隙性脑梗死组中,与良好预后比较,不良预后与高龄有关,差异有统计学意义(P<0.05);在非腔隙性脑梗死组中,与良好预后比较,不良预后与高血糖、高龄、意识改变有关,差异有统计学意义(P<0.01或<0.05)。多变量分析显示高血糖与非腔
3、隙性脑梗死预后不良有关(OR=0.71,P=0.008),但能改善腔隙性脑梗死的预后(OR=2.76,P=0.052)。随着血糖上升,在非腔隙性脑梗死中,有益预后的优势比逐渐下降;而在腔隙性脑梗死中,有益预后与血糖≥8mmol/L有关,但当血糖>10mmol/L,这种趋势消失。结论高血糖与非腔隙性脑梗死的预后不良有关,但适度高血糖可改善腔隙性脑梗死的预后。关键词:脑血管意外;高血糖症;脑梗塞中图分类号:R743文献标识码:A文章编号:10042583X(2009)0520406203Effectof
4、hyperglycaemiaonprognosisinacuteischemicstrokesubtypeZHANGPing,LIMan2lianDepartmentofNeurology,thePeople'sHospitalofYongzhou,Yongzhou425000,ChinaABSTRACT:ObjectiveToexplorewhethertheeffectofhyperglycaemiaonstrokeoutcomeissimilarinbrainlacunarandnon2lac
5、unarinfarctions.MethodsTherelationbetweenserumglucosemeasuredwithin8hoursafterstrokeonsetandfunctionaloutcomewasinvestigatedin248ischaemicstrokepatientsusingprospectivearraymethod.Theendpointwasafavourableoutcome,definedasamodifiedRankinScalescore≤2at3
6、months.Classificationprovedintolacunarinfarction(n=62)andnon2lacunarinfarction(n=186);strokeswerebasedonclinicalcriteriaaccordingtotheOxfordshireCommunityStrokeProjectandfindingsonbrainCTscan.Hyperglycaemiawasdefinedasbloodglucose≥8mmol/L.ResultsGlucos
7、elevel,previoushypertensionanddisordersofconsciousnessatadmissioninnon2lacunarstrokewerehigherthanthoseinlacunarstroke,significantdifferencesexistedbetweentwogroups(P<0.01or0.05).Intheunivariateanalysis,elderagewassignificantlyassociatedwithworseoutcom
8、einlacunargroup(P<0.05);hyperglycaemia,elderageanddisordersofconsciousnesswereassociatedwithanunfavourableoutcomeinnon2lacunarstroke(P<0.01or0.05).Multivariateanalysisshowedthathyperglycaemiawasassociatedwithdecreasedoddsofafavourableou
