摘要
目的:探讨急性脑梗死糖调节受损(IGR)的分布情况,并就FG、HbA1c、餐后2h血糖及胰岛素对急性脑血管患者血糖评估的价值进行重新评价。方法:测定2007年1月—2008年12月急性脑梗死患者的空腹血糖及胰岛素、餐后2h血糖及胰岛素、HbA1c等,按世界卫生组织的正常血糖、IGR、糖尿病诊断标准进行评定,了解IGR在急性脑血管病的分布情况,并对以上各指标的临床价值进行重新评估。结果:263例急性脑梗死患者既往已确诊有2型糖尿病史者103例,经连续2次空腹血糖测定≥7.0mmol.L-1而新确诊为2型糖尿病者17例,IGR5例;经口服糖耐量试验(OGTT)试验后新诊糖尿病患者36例,即入院后的急性脑梗死患者中新诊糖尿病患者为53例,占总病例数的20.15%,在263例患者,最终确诊糖尿患者数为156例,即合并糖尿患者比例由入院时的39.16%增加至59.32%;另新诊断IGR患者27例,其中IFG10例,I-IGT12例,IFG+IGT5例,糖代谢异常率由入院时的47.53%上升至OGTT试验后的69.58%。NGT组、IGR组、DM组的HbA1c异常率分别为5/80(6.25%),13/27(48.15%),132/156(84.62%),空腹胰岛素值分别为:10.06±9.28,9.55±5.42,9.98±5.26mU.L-1,餐后2h胰岛素分别为28.18±18.06,50.77±32.37,35.6±27.2mU.L-1。NIHSS评分分别为4.21±2.27,4.80±2.81,5.83±2.88。结论:急性脑梗死患者中存在广泛的糖代谢异常,仅据空腹血糖和既往糖尿病史将使81.48%IGR、20.15%糖尿病病人漏诊,对急性脑血管病人进行餐后2h血糖及胰岛素、HbA1c测定有利于对患者血糖的正确评估及治疗。
Objective：To assess the distribution of DM,impaired glucose regulation （IGR） include impaired fasting glucose （IFG）, impaired glucose tolerance （IGT）, and combined IFG/IGT in patients with acute cerebral infarction disease. Methods： We studied 263 patients with acute cerebral infarction disease. FPG,OGTT, HbAle and Insulin were measured within 24h.NIHSS were assessed simultaneously. Categories of glucose tolerance were defined according to 2003 modified American Diabetes Association criteria. Results： （1） At entry, 103 patients had known type 2 diabetes and 17 had newly diagnosed diabetes （FPG≥7.0 mmol · L^-1 , measured 2 times）. Oral glucose tolerance tests （OGTT） performed in the remaining patients revealed that 36 cases were diagnosed as diabetes and 27cases as impaired glucose regulation （IGR）. Overall,the proportion of patients with diagnosed diabetes increased from 39.16M at baseline to 59.32% post-OGTT analysis. In total, 81.48% of patients with IGR and 20.15 % of patients with diabetes would have remained undiagnosed if OGTTs had not been performed. （2） Abnormal HbA1c were 5/80（6.25%） ,13/27（48.15%） ,132/156（84.62%） in NGT group, IGR group and DM group respective. Fasting insulin were 10.06±9.28,9.55±5.42,9.98±5.26mU · L6-1. 2h insulin after oral food were 28.18± 18.06,50.77 ±32.37,35.6 ± 27.2 mU ·L^-1. NIHSS were 4.21 ± 2.27,4.80 ±2.81,5.83± 2.88 in three group respective. Conelusion：Glucometabolic abnormal include IGR and DM were more common in patients with acute cerebral infarction than our estimate before. FPG, OGTT, HbAlc and insulin should be routinely used to assess the glueometabolie state of these patients.
出处
《中国临床医学》
2009年第3期348-351,共4页
Chinese Journal of Clinical Medicine
基金
中华医学会心脑血管疾病血糖管理协作组(CGICC)医学科研资金支持项目(08020015)
