摘要
目的探讨卒中合并糖尿病患者不良预后的危险因素,为临床预后评估和治疗决策提供科学依据。方法回顾性选取2023年1月—2024年12月长治医学院附属和平医院神经内科住院治疗的110例卒中合并糖尿病患者的临床资料。根据入院3个月时改良Rankin量表(Modified Rankin Score,mRS)评分将患者分为预后良好组(mRS 0~2分,62例)和预后不良组(mRS 3~6分,48例)。收集两组患者的基本资料、卒中特征、血糖控制情况、实验室指标,采用单因素分析和多因素二元Logistic回归分析卒中合并糖尿病患者不良预后的独立危险因素。结果两组患者的年龄、糖尿病病程、入院美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、大面积梗死和基底节区病变发生情况、入院血糖水平、糖化血红蛋白水平、血糖变异系数和实验室指标(白细胞计数、中性粒细胞、血红蛋白、血小板、肌酐、尿素氮、C反应蛋白和D-二聚体)比较,差异均有统计学意义(P均<0.05)。多因素二元Logistic回归分析显示,年龄≥70岁、入院NIHSS评分≥13分、发生大面积梗死和基底节区病变、糖化血红蛋白≥7%、白细胞计数≥10×10^(9)/L、中性粒细胞百分比≥75%、血小板计数≥200×10^(9)/L、肌酐≥90μmol/L、C反应蛋白≥20 mg/L和D-二聚体≥2.0 mg/L是卒中合并糖尿病患者不良预后的独立危险因素(P均<0.05)。结论高龄、卒中严重程度高、血糖控制不良、血糖波动幅度大、炎症反应激活和肾功能损害是卒中合并糖尿病患者不良预后的独立危险因素。临床实践中应重点关注这些高危因素,制订个体化治疗策略以改善患者预后。
Objective To explore the risk factors of poor prognosis in stroke patients with diabetes mellitus,and to provide scientific basis for clinical prognosis evaluation and treatment decision-making.Methods The clinical data of 110 stroke patients with diabetes mellitus who were hospitalized in the Department of Neurology,Heping Hospital Affiliated to Changzhi Medical College from January 2023 to December 2024 were retrospectively selected.According to the Modified Rankin Score(mRS)at 3 months after admission,the patients were divided into good prognosis group(mRS 0-2 points,62 cases)and poor prognosis group(mRS 3-6 points,48 cases).The basic data,stroke characteristics,blood glucose control and laboratory indexes of the two groups were collected.Univariate analysis and multivariate binary Logistic regression analysis were used to analyze the independent risk factors of poor prognosis in stroke patients with diabetes mellitus.Results There were statistically significant differences in age,duration of diabetes,admission National Institutes of Health Stroke Scale(NIHSS)score,incidence of massive infarction and basal ganglia lesions,admission blood glucose level,glycated hemoglobin A1c level,coefficient of variation of blood glucose and laboratory indexes(white blood cell count,neutrophils,hemoglobin,platelets,creatinine,urea nitrogen,C-reactive protein and D-dimer)between the two groups(all P<0.05).Multivariate binary Logistic regression analysis showed that age≥70 years old,admission NIHSS score≥13 points,large area infarction and basal ganglia lesions,glycated hemoglobin A1c≥7%,white blood cell count≥10×10^(9)/L,neutrophil percentage≥75%,platelet count≥200×10^(9)/L,creatinine≥90μmol/L,C-reactive protein≥20 mg/L and D-dimer≥2.0 mg/L were independent risk factors for poor prognosis in stroke patients with diabetes(all P<0.05).Conclusion Old age,high severity of stroke,poor blood glucose control,large fluctuation of blood glucose,activation of inflammatory response and renal impairment are independent risk factors for poor prognosis in stroke patients with diabetes mellitus.In clinical practice,we should focus on these highrisk factors and formulate individualized treatment strategies to improve the prognosis of patients.
作者
李良
张沁丽
李小梅
LI Liang;ZHANG Qinli;LI Xiaomei(Department of Neurology,Heping Hospital Affiliated to Changzhi Medical College,Changzhi 046000,Shanxi,China)
出处
《糖尿病新世界》
2025年第23期34-38,共5页
Diabetes New World
关键词
卒中
糖尿病
预后
危险因素
血糖变异性
Stroke
Diabetes mellitus
Prognosis
Risk factors
Blood glucose variability
