·糖尿病神经病变·

　　【摘要】 目的 探讨T2DM合并急性脑梗死(ACI)中患者血糖水平及血糖漂移对神经功能缺损及预后的临床意义。 方法 纳入91例ACI患者，根据有无糖尿病史及入院24 h内空腹血糖情况分为糖尿病(A)组28例、单纯应激性高血糖(B)组27例及血糖正常(C)组36例，入院早期行72 h动态血糖监测(CGMS)，根据《中国脑卒中神经功能缺损评分标准》(CSS)，对比3组神经功能缺损程度，并与治疗2周后进行比较。 结果 (1)A组女性比例、有陈旧性脑梗死及高血压史患者比例高于B、C组(P<0.05);TG、TC、HDL-C、血清同型半胱氨酸(HCY)、尿白蛋白/肌酐比值(UACR)、胰岛素抵抗指数(HOMA-IR)、C-RP高于B、C组(P<0.01);(2)HbA1c、餐后2 h平均血糖(MPBG)、血糖水平标准差(SDBG)、日内血糖波动幅度(MAGE)和日间血糖波动绝对差(MODD)高于B、C组(P<0.01)。治疗2周后，A组CSS评分高于B、C组(P<0.01);(3)MAGE与CSS评分、HCY、HOMA-IR均相关(P<0.05);CSS评分与CRP、HCY、HOMA-IR相关(P<0.05);多重线性回归分析结果提示，日内血糖波动幅度、C-RP与CSS评分呈独立相关关系。(4)A组病灶以多发脑梗死以及椎-基底动脉系统梗死为主。(P<0.01)。 结论 T2DM合并ACI患者血糖波动较大，神经功能缺损更严重。血糖波动可能加重ACI进展，与预后相关。

　　【关键词】 急性脑梗死;糖尿病，2型;血糖波动

Glucose fluctuation and its significance of early phase of acute ischemic stroke in patient with type 2 diabetes mellitus HUANG Jin-xin,LV Xiao-feng, LI Juan,et al. Department of Endocrinology,The Military General Hospital of Beijing，Beijing 100700，China

Corresponding author: LV Xiao-fen, E-mail:neifenmike@126.com

　　【Abstract】 Objective To investigate the significance of glucose level and glucose fluctuation on neurologic impairment during early phase of acute ischemic stroke in patient with T2DM. Methods Ninety-one patients with acute ischemic stroke were included and divided into T2DM(A)group , stress hyperglycemia (B) group and normal glucose (C) group. 72 h continuous glucose monitoring (CGMS)was tested in all subjects Results (1) The ratio of female patients, cerebral infarction history and hypertension history in group A were significantly higher than in group B and C (P<0.05). The levels of TC, TG ,LDL-C, UACR, HOMA-IR , C reactive protein (C-RP)and homocysteine (HCY) in group A were significantly higher than in group B and C(P<0.01). (2)The levels of HbA1c, MPBG, standard deviation of blood glucose(SDBG), mean amplitude of glycemia excursion(MAGE),and absolute mean of daily difference(MODD) were significantly higher in group A versus group B and C (all P<0.01). The CSS scores of the acute ischemic stroke in group A were higher than in B and C groups at 14 d after treatment. (3) MAGE was correlated with CSS score, HCY, HOMA-IR.(P<0.05). CSS score were correlated with C-RP, HCY, HOMA-IR respectively (P<0.05). Multiple stepwise regression analysis showed that MAGE, HCY were the impact factors of CSS. (4) The lesions of the group A were dominated by multi-cerebral infraction as well as vertebral basilar arterial system(P<0.01). Conclusion T2DM patients with acute ischemic stroke have the higher blood glucose excursion and the more serious neurological function impairment .Glucose fluctuation may aggravate the progression and prognosis of acute ischemic stroke.

　　【Key words】 Ischemic stroke, acute; Diabetes mellitus type 2; Blood glucose fluctuation