糖化血红蛋白与大动脉粥样硬化性缺血性卒中患者预后的关系研究

目的探讨急性缺血性卒中患者入院时糖化血红蛋白与不良心脑血管预后及神经功能预后的关系。方法入选2010年5月至2011年8月首都医科大学附属北京天坛医院脑血管病中心急性缺血性卒中住院患者373例,所有患者均为TOAST分型大动脉粥样硬化型。记录患者的基线资料,按照入院时患者糖化血红蛋白≥7%或7%进行分组并随访。终点事件包括卒中复发、心脑血管事件和心脑血管死亡、随访一年的神经功能恢复情况改良Rankin量表(modified Rankin Scale,m RS)]。结果共300例患者资料纳入分析,高糖化血红蛋白组83例,低糖化血红蛋白组217例。随访(18.9±5.0)个月。高糖化血红蛋白组糖尿病发病率、1年的m RS评分、心脑血管事件均显著高于低糖化血红蛋白组(P0.01),Kaplan-Meier生存分析显示高糖化血红蛋白组患者无心脑血管事件的生存明显低于低糖化血红蛋白组(P0.001)。Cox回归发现糖化血红蛋白(HR 1.252,95%CI 1.061~1.477,P=0.008)和既往卒中史(HR 2.630,95%CI 1.365~4.970,P=0.004)是卒中患者心脑血管预后不良的预测因素。Logistic回归分析显示缺血性卒中患者随访一年时神经功能恢复不良的独立危险因素有高龄(OR 1.069,95%CI 1.037~1.101,P0.001)、既往有卒中史(OR 4.087,95%CI 2.051~8.144,P0.001)、高糖化血红蛋白(OR 1.208,95%CI 1.002~1.455,P=0.047)和入院美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(OR 1.320,95%CI 1.217~1.431,P0.001)。结论入院时糖化血红蛋白升高是大动脉粥样硬化性急性缺血性卒中患者一年不良心脑血管预后和不良功能预后的预测因素。

Association between Hemoglobin A1e and Outcome in Patients with Acute Ischemic Stroke

Objective To investigate the association between hemoglobin A1c (HbA1c) and cardiovascular
and functional outcome in patients with acute ischemic stroke.
Methods A total of 373 inpatients with acute ischemic stroke were recruited and followed up
at Cerebrovascular Center of Beijing Tiantan Hospital between May 2010 and August 2011. All
patients were diagnosed as TOAST Aorta Atherosclerotic type. The baseline data were recorded.
The patients were divided into different groups with the benchmark of HbA1c ≥7% or <7% and
were followed up. The endpoint events included stroke recurrence, vascular events, cardiovascular
death, and functional status (modified Rankin Scale, mRS) at one year.
Results The data of 300 patients were included in the final analysis. The patients were divided into
the two groups according to ≥7% or <7%: higher HbA1c group (83 patients) and lower HbA1c
group (217 patients). The patients were followed up for 18.9±5.0 months. The patients in higher
HbA1c group showed a higher prevalence of diabetes mellitus and cardiovascular events, higher
mRS at one year than those in lower HbA1c group (P <0.01). Kaplan-Meier analysis found that the
cardiovascular events-free survival was lower in higher HbA1c group than that in lower HbA1c
group (P <0.001). Cox regression found HbA1c (HR 1.252, 95%CI 1.061~1.477, P =0.008) andprevious stroke (HR 2.630, 95%CI 1.365~4.970, P =0.004) were the predictive factors for poor
cardiovascular outcome in stroke patients. Logistic regression found that age (OR 1.069, 95%CI
1.037~1.101, P <0.001), previous stroke (OR 4.087, 95%CI 2.051~8.144, P <0.001), HbA1c (OR
1.208, 95%CI 1.002~1.455, P =0.047) and National Institutes of Health Stroke Scale (NIHSS) score
on admission (OR 1.320, 95%CI 1.217~1.431, P <0.001) were the risk factors for functional status
at one year.
Conclusion Our study suggests that the HbA1c on admission is an independent significant
predictor for poor cardiovascular outcome and functional outcome in patients with aorta
atherosclerotic ischemic stroke.