糖化血红蛋白与急性脑卒中再灌注治疗后新发病灶的相关性研究

Associations of glycated hemoglobin with new lesions in acute stroke patients after reperfusion therapy

摘要:

目的 探讨糖化血红蛋白（HbA1c）与急性脑卒中再灌注治疗后新发病灶的相关性。方法 回顾性分析2017年1月—2019年6月盐城市中医院入院并接受再灌注治疗的脑卒中患者74例，于治疗前及治疗后24 h内接受MRI检查。根据TOAST分型标准，将急性脑卒中分为5个亚型。收集所有患者一般临床资料。统计学方法分析HbA1c与急性脑卒中再灌注治疗后新发病灶的相关性。结果 74例脑卒中患者经再灌注治疗后MRI复查显示44例（59.46%）出现新发病灶。新发病灶组HbA1c高于无新发病灶组［（6.09±1.03） VS （5.50±0.76）］（P <0.05）；新发病灶组HbA1c升高高于无新发病灶组［43.18% VS 16.67%］（P <0.05）。44例新发病灶的患者中，28例（63.64%）为局部新发病灶，16例（36.36%）为远端新发病灶。远端新发病灶组HbA1c高于局部新发病灶组［（6.64±0.87） VS （5.78±0.99）］（P <0.05）；远端新发病灶组HbA1c升高高于局部新发病灶组［68.75% VS 28.57%］（P <0.05）。Spearman相关性分析显示HbA1c与新发病灶呈正相关（r_s =0.384，P <0.05）。Logistic回归分析结果显示HbA1c升高［R=3.800（95% CI：1.227，11.768）］为预测卒中新发病灶发生的独立预测因子（P <0.05）。结论 治疗前检测HbAlc有助于预测急性脑卒中患者新发病灶的发生。

Abstract:

Objective To explore the associations of glycated hemoglobin (HbA1c) with new lesions in acute stroke patients after reperfusion therapy.Methods In this retrospective study, seventy-four acute stroke patients who received reperfusion therapy in our hospital were analyzed. All patients underwent MR examination before therapy and after therapy within 24 h. Stroke subtype was classified according to TOAST criteria. The proportion of HbA1c elevation and other clinical data were collected. Statistical analysis was used to analyze the correlation between HbA1c and new lesions in acute stroke patients.Results A total of 74 acute stroke patients received reperfusion therapy. After reperfusion therapy, 44 patients (59.46%) had new lesions on MRI. New lesions group had higher HbA1c and proportion of elevated HbA1c than that in non-new lesions group [(6.09 ± 1.03) VS (5.50 ± 0.76), 43.18% VS 16.67%], the difference was statistically significant (P < 0.05). Of 44 patients with new lesions, 28 (63.64%) were new local lesions and 16 (36.36%) were new distant lesions. Compare with new local lesions group, patients with new distant lesions had significantly higher HbA1c and proportion of elevated HbA1c [(6.64 ± 0.87) VS (5.78 ± 0.99), 68.75% VS 28.57%] (P < 0.05). Spearman's rank correlation analysis revealed that HbA1c was positively correlated with new lesions (r_s = 0.384, P < 0.05). Logistic analysis demonstrated that elevated HbA1c [b =1.751, S_b = 0.599, Wald χ² = 6.867, R = 3.800 (95% CI: 1.227, 11.768)] were independently associated with new lesions (P < 0.05).Conclusions Detection of HbA1c before therapy can help to predict the new lesions in acute stroke patients.