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目的探讨糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)在预测2型糖尿病并缺血性脑卒中患者发生再次脑血管事件(recurrent cerebrovascular event,RCE)中的价值。方法 2型糖尿病并缺血性脑卒中患者146例,依据入院时HbA1c水平分为高水平组(HbA1c≥6.0%)87例和正常组(HbA1c<6.0%)59例,比较2组入院次日空腹血糖(fasting plasma glucose,FPG)、餐后2h血糖(2hpostprandial plasma glucose,PPG)、总胆固醇(total cholesterol,TC)、三酰甘油(triacylglycerol,TG)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)水平和入院时神经功能损伤程度;2组均给予脱水、降压、改善脑循环、营养神经、控制血糖等治疗,连续治疗3周后评定疗效;随访24个月,统计RCE发生情况,比较发生RCE者和未发生RCE者入院时HbA1c水平。结果高水平组入院次日FPG[(8.94±2.33)mmol/L]、PPG[(13.07±3.82)mmol/L]、TC[(6.09±1.37)mmol/L]、TG[(1.92±0.53)mmol/L]、LDL-C[(4.11±1.13)mmol/L]水平高于正常组[FPG(6.72±2.61)mmol/L,PPG(9.36±4.11)mmol/L,TC(4.95±1.00)mmol/L,TG(1.14±0.33)mmol/L,LDL-C(2.98±1.05)mmol/L],HDL-C水平[(1.03±0.27)mmol/L]低于正常组[(1.45±0.34)mmol/L](P<0.05);高水平组入院时中重度神经功能损伤发生率(87.36%)高于正常组(38.98%)(P<0.05);2组连续治疗3周后,高水平组好转率(75.86%)低于正常组(94.92%)(P<0.05);随访24个月,146例中45例发生RCE,发生RCE者入院时HbA1c水平[(9.24±2.13)%]高于未发生RCE者[(6.07±1.86)%](P<0.05)。结论 HbA1c水平增高的2型糖尿病并缺血性脑卒中患者易发生RCE,检测入院时HbA1c水平有助于预测其发生RCE的风险。
Objective To investigate the value of glycosylated hemoglobin A1c (HbA1c) in the prediction of recurrent cerebrovascular event (RCE) in type 2 diabetic patients with ischemic stroke. Methods A total of 146 patients with type 2 diabetes mellitus and ischemic stroke were divided into two groups according to HbA1c admission: 87 in the high-grade group (HbA1c≥6.0%) and 59 in the normal group (HbA1c≤6.0%), Fasting plasma glucose (FPG), postprandial 2h postprandial plasma glucose (PPG), total cholesterol (TC), triacylglycerol (TG), low density lipoprotein- (LDL-C), high density lipoprotein-cholesterol (HDL-C), and neurological damage on admission. Both groups were given dehydration and antihypertensive drugs to improve brain circulation, nourish nerves and control blood sugar After 3 weeks of continuous treatment, the curative effect was evaluated. After 24 months of follow-up, the incidence of RCE was calculated, and HbA1c levels were compared between admission of RCE and those without RCE. Results The levels of FPG (8.94 ± 2.33 mmol / L), PPG (13.07 ± 3.82 mmol / L), TC [6.09 ± 1.37 mmol / L] and TG [(1.92 ± 0.53) (4.11 ± 1.13) mmol / L] and LDL-C [4.11 ± 1.13 mmol / L] were significantly higher than those in the normal control group [FPG 6.72 ± 2.61 mmol / L and PPG 9.36 ± 4.11 mmol / (1.14 ± 0.33) mmol / L, LDL-C (2.98 ± 1.05) mmol / L], and HDL-C levels were significantly lower than those in the normal group [(1.45 ± 0.34 ) mmol / L] (P <0.05). The incidence of moderate and severe neurological injury in high-level group was significantly higher than that in normal group (87.36% vs 38.98%, P <0.05) The improvement rate of the level group (75.86%) was lower than that of the normal group (94.92%) (P <0.05). At the 24-month follow-up, RCE was found in 45 of 146 cases (HbA1c level of 9.24 ± 2.13% Higher than those without RCE [(6.07 ± 1.86)%] (P <0.05). Conclusions RCE is more likely to occur in patients with type 2 diabetes mellitus and ischemic stroke with increased levels of HbA1c. To detect the level of HbA1c on admission may be helpful to predict the risk of developing RCE.