糖化血红蛋白水平对糖尿病并发缺血性脑卒中患者再次脑血管事件的预测价值

目的:探讨糖化血红蛋白水平(HbA1c)对糖尿病(DM)并发缺血性脑卒中(IS)患者再次脑血管事件(SCE)的预测作用。方法:连续收集2008年6月至2011年6月DM并发IS患者168例。入院后测定HbA1c水平,收集临床资料。依据HbA1c水平将患者分为HbA1c升高组(HbA1c≥6.1%)和HbA1c正常组(HbA1c<6.1%)。对所有患者出院后18个月内SCE进行随访(每2个月一次),依据是否发生SCE将患者分为事件组和非事件组。采用受试者工作特征(ROC)曲线评价HbA1c水平对SCE的预测价值。结果:与HbA1c正常组(n=75)相比,HbA1c升高组(n=93)入院时空腹血糖、2 h餐后血糖、收缩压、胆固醇、甘油三酯及低密度脂蛋白胆固醇水平均升高,高密度脂蛋白胆固醇水平和Barthel指数均明显降低(均P<0.01)。事件组49例,HbA1c水平为(9.57±1.93)%;非事件组119例,HbA1c水平为(6.96±2.40)%,前者高于后者(P<0.01)。ROC曲线下面积为0.784(P<0.01,95%CI为0.713~0.855),取HbA1c水平6.55%为预测临界值的灵敏度和特异度分别为86.80%和64.30%。Kaplan-Meier生存曲线提示HbA1c水平≥6.55%时,SCE发生率增高(P<0.01)。结论:DM合并IS患者首次入院时HbA1c水平可能对出院后18个月内SCE进行预测。

Predictive Value of Glycosylated Hemoglobin Level on the Secondary Cerebrovascular Event of Diabetic Patients with Ischemic Stroke

ObjectiveTo observe the predictive value of glycosylated hemoglobin （HbA1c） level on the secondary cerebrovascular events （SCE）of diabetic patients with ischemic stroke. Methods：From June 2008 to June 2011, 168 diabetic patients with ischemic stroke were admitted. The patients were divided into elevated HbA1c group （HbA1c≥6.1%） and normal HbA1c group （HbA1c〈6.1%）. All the patients have been followed up every two month and the occurrence of SCE was documented in 18 months. According to the follow-up data, the patients were assigned into the event and non-event groups. The power of HbA1c levels to predict SCE was exam-ined by receiver operating characteristic （ROC） curve. Results：When compared with the normal HbA1c group （n=75）, the fasting blood glucose, postprandial blood glucose, systolic pressure, cholesterol, triglyceride and low density lipoprotein cholesterol were significantly increased, while high density lipoprotein cholesterol and Barthel index were significantly decreased in elevated HbA1c group （n=93）（all P〈 0.01）. At the endpoint, there were 49 and 119 patients in the event group and non-event group respectively. When compared with the non-event group, the HbA1c level was higher in the event group [（6.96±2.40）% （9.57±1.93）%,（ P〈0.01）. The area under the ROC curve （AUC） of HbA1c level to predict the SCE was 0.784 （ P〈0.01, 0.713-0.855）. The cut-off value of HbA1c was 6.55%, with a sensitivity of 86.80%and a specificity of 64.30%. The Kaplan-Meier survival curve showed that the occurrence of SCE was increased in the patients with HbA1c level≥6.55%. Conclusion：The ele-vated HbA1c level may be a significant predictor for SCE in diabetic patients with ischemic stroke in 18 months.