血糖变异性与急性脑梗死伴糖尿病患者 短期认知功能的相关性分析

Association of blood glucose variability with short-term cognitive function in patients with acute cerebral infarction complicated with diabetes mellitus

摘要:

目的 探讨血糖变异性与急性脑梗死伴糖尿病患者短期认知功能的相关性。方法 选取2015 年3 月-2017 年3 月德州市人民医院接受治疗的124 例急性脑梗死伴糖尿病患者为研究对象。统计一般资料，入 院24 h 内对其进行72 h 动态血糖监测，统计其平均血糖值（GluAve）、血糖标准差（GluSD）、24 h 平均血 糖波动幅度（MAGE）、血糖不稳定指数（GLI）、血糖变异率（GV）。入院时、入院2 周时应用美国国立卫 生院卒中量表（NIHSS）、蒙特利尔认知评估量表（MoCA）测评患者短期认知功能。根据MoCA 得分将患 者划分为认知功能障碍组和认知功能正常组，比较两组各基线指标差异，评估动态血糖监测指标与入院2 周 时NIHSS、MoCA 的相关性，以及动态血糖监测指标对预测认知功能障碍的效能。结果 认知功能障碍组空 腹血糖、糖化血红蛋白、GluAve、GluSD、MAGE、GLI、GV 均高于认知功能正常组（P <0.05）。GluAve、 GluSD、MAGE、GLI、GV 与入院2 周时NIHSS 评分呈正相关、与MoCA 评分呈负相关，相关性差异有统 计学意义（P <0.05）。GluAve、GluSD、MAGE、GLI、GV 对预测认知功能障碍均有可靠价值，受试者工作 特征曲线下面积为0.675 ～ 0.927（P <0.05）。结论 GluAve、GluSD、MAGE、GLI、GV 均与急性脑梗死伴 糖尿病患者短期认知功能障碍有关，早期检测血糖变异性，降低血糖并减少血糖波动可能有助于改善患者预后。

Abstract:

Objective To investigate the correlation between blood glucose variability and short-term cognitive function in the patients with acute cerebral infarction complicated with diabetes mellitus. Methods Totally 124 patients of acute cerebral infarction complicated with diabetes mellitus treated in our hospital from March 2015 to March 2017 were involved. Their general data were observed. The average blood glucose (GluAve), standard deviation of glucose (GluSD), mean amplitude of glycemic excursions in 24 h (MAGE), glycemic index (GLI) and glucose variability (GV) were detected by 72-h dynamic monitoring of blood glucose started within 24 h after admission. The short-term cognitive function of the patients was measured by National Institute of Health Stroke Scale (NIHSS) and Montreal Cognitive Assessment Scale (MoCA) at admission and 2 w after admission. The patients were divided into a cognitive dysfunction group and a normal cognition group according to MoCA score. The differences in baseline indicators were compared between the two groups. The correlations between blood glucose variability and short-term cognitive function were analyzed, and the predicting value of blood glucose variability on cognitive dysfunction was observed. Results The fasting blood glucose, glycosylated hemoglobin, GluAve, GluSD, MAGE, GLI and GV in the cognitive dysfunction group were significantly higher than those in the normal cognition group (P < 0.05). GluAve, GluSD, MAGE, GLI and GV were positively correlated with the NIHSS score, and negatively correlated with the MoCA score 2 w after admission (P < 0.05). GluAve, GluSD, MAGE, GLI and GV had reliable value in predicting cognitive dysfunction, the area under the ROC curve ranged from 0.675 to 0.927 (P < 0.05). Conclusions GluAve, GluSD, MAGE, GLI and GV are all correlated with short-term cognitive dysfunction in the patients with acute cerebral infarction complicated with diabetes mellitus. Detection of blood glucose variability in early stage, reduction of blood glucose and blood glucose fluctuation may help to improve the prognosis of the patients.