缺血性卒中后应激性高血糖与早期血管性认知功能障碍的相关性

doi:10.3881/j.issn.1000-503X.2017.06.003

Acta Academiae Medicinae Sinica

Acta Academiae Medicinae Sinica ›› 2017, Vol. 39 ›› Issue (6): 749-755.doi: 10.3881/j.issn.1000-503X.2017.06.003

• Original Articles • Previous Articles Next Articles

Correlation of Stress Hyperglycemia after Ischemic Stroke with Early Vascular Cognitive Impairment

Yidong ZHOU^1,², Huaiwu YUAN¹, Renjie JI¹, Benyan LUO¹()

¹Department of Neurology,the First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou 310003,China
²Department of Neurology,Ningbo First Hospital,Ningbo,Zhejiang 315000,China

Received:2016-11-24 Online:2017-12-20 Published:2017-12-20
Supported by:
Supported by the “12th Five-Year” National Science and Technology Supporting Program (2011BAI08B02)

Abstract

Abstract:

Objective To investigate the influence and forecast value of stress hyperglycemia on the early vascular cognitive impairment (VCI) in stroke patients.Methods Totally 422 patients with acute non-diabetic stroke were divided into three groups according to the fasting plasma glucose level:the euglycemia group (<6.1 mmol/L),the mild stress hyperglycemia group (6.1-7.0 mmol/L),and the severe stress hyperglycemia group (≥7.0 mmol/L).Mini-mental state examination,Alzheimer’s disease rating scale cognitive subscale,and clinical dementia rating scale were used to evaluate early cognition in post-stroke patients,and patients were divided into three groups accordingly:normal cognitive function group,mild VCI group,and vascular dementia group.Correlation analysis was carried out on the level of stress hyperglycemia and the degree of VCI.Results Of these 422 patients,stress hyperglycemia was identified in 62 cases (14.7%).The risk of stress hyperglycemia was higher in patients with a high degree of education [(8.39±3.85)years vs.(6.62±4.39)years,P=0.037)] or a history of cardiovascular disease (45.2% vs.18.3%,P=0.001).VCI was detected in 270 patients (64.0%).Age,sex,smoking,National Institute of Health Stroke Scale score,Hamilton Depression Rating Scale score,stress hyperglycemia,and history of cardiovascular disease were related with early VCI after non-diabetic ischemic stroke (P<0.05).Multivariate Logistic regression analysis showed that stress hyperglycemia was an independent risk factor for VCI in patients with non-diabetic ischemic stroke (OR=3.086,95% CI=1.065-8.929).The risks of cognitive impairment in the mild stress hyperglycemia group and the severe stress hyperglycemia group were higher than that of the euglycemia group,while it was also higher in the severe stress hyperglycemia group than in the mild stress hyperglycemia group (61.11% vs.75.00% vs.90.91%).Stress hyperglycemia was positively correlated with the high risk of early cognitive impairment in stroke patients (r_s=0.185,P=0.007).Conclusion There is a significant correlation between stress hyperglycemia and early VCI after ischemic stroke.

Key words: ischemic stroke, stress hyperglycemia, vascular cognitive impairment

CLC Number:

R741

Yidong ZHOU, Huaiwu YUAN, Renjie JI, Benyan LUO. Correlation of Stress Hyperglycemia after Ischemic Stroke with Early Vascular Cognitive Impairment[J].Acta Academiae Medicinae Sinica, 2017, 39(6): 749-755.

Figures/Tables 4

Table 1

Comparison of baseline data between normal glucose group and stress hyperglycemia group"

分组 Group	年龄( $x ?$ ±s,岁) Age( $x ?$ ±s,year)	男性Male [n (%)]	高血压病史 Hypertension [n (%)]	高总胆固醇血症 Hyper cholesterolemia [n (%)]	教育( $x ?$ ±s,年) Education ( $x ?$ ±s,year)	体质量指数 Body mass index ( $x ?$ ±s,kg/m²)
血糖正常组 Normal glucose group(n=360)	60.91±12.66	240 (66.7)	230 (63.9)	20(5.6)	6.62±4.39	23.56±3.47
应激性高血糖组 Stress hyperglycemia group (n=62)	60.94±11.04	50(80.6)	44(71.0)	2(3.2)	8.39±3.85	23.65±3.78
t/χ²/Wilcoxon W	-0.010	2.404	0.582	0.290	-2.099	-0.116
P	0.992	0.121	0.446	0.590	0.037	0.908
分组 Group	卒中史 Stroke history [n (%)]	心血管病史 Cardiovascular disease history [n (%)]	吸烟史 Smoking history [n (%)]	饮酒史 Drinking history [n (%)]	采血与发病间隔 [中位数(四分位数间距),d] Interval between blood sampling and attack[median (quartile range),d]
血糖正常组 Normal glucose group(n=360)	42 (11.7)	66(18.3)	164 (45.6)	150 (41.7)	2.00(1.00,2.00)
应激性高血糖组 Stress hyperglycemia group (n=62)	2(3.2)	28(45.2)	34(54.8)	36(58.1)	2.00(1.00,2.00)
t/χ2/Wilcoxon W	2.017	10.994	0.915	2.885	2991.000
P	0.155	0.001	0.339	0.089	0.309

Table 1

Table 2

Table 3

Univariate analysis of vascular cognitive impairment with early occurrence in post-ischemic stroke time"

分组 Group	年龄( $x ?$ ±s,岁) Age( $x ?$ ±s,year)	男性 Male [n (%)]	高血压病 Hypertension [n (%)]	卒中史 Stroke history [n (%)]	心血管病史 Cardiovascular disease history[n (%)]	吸烟史 Smoking history [n (%)]
认知正常组 Normal cognitive function group (n=152)	57.34±13.754	122 (80.3)	90 (59.2)	10 ( 6.6)	20 (13.2)	94 (61.8)
认知障碍组 Cognitive impairment group (n=270)	62.93±11.137	168 (62.2)	184 (68.1)	34 (12.6)	74 (27.4)	104 (38.5)
t/χ²/Wilcoxon W	-3.025	7.363	1.706	1.883	5.703	10.621
P	0.003	0.007	0.192	0.170	0.017	0.001
分组 Group	饮酒史 Drinking history [n (%)]	NIHSS 评分 [中位数(四分位数间距)] NIHSS score[median (quartile range)]		HAMD 评分 [中位数(四分位数间距)] HAMD score [median (quartile range)]	应激性高血糖 Hyperglycemia [n (%)]
认知正常组 Normal cognitive function group (n=152)	68 (44.7)	2.00(1.00,4.00)		3.00(1.00, 7.00)	12 ( 7.9)
认知障碍组 Cognitive impairment group (n=270)	118 (43.7)	3.00(1.00,5.00)		5.00(2.00,10.00)	50 (18.5)
t/χ²/Wilcoxon W	0.021	7485.000		6613.000	4.379
P	0.885	0.017		0.001	0.036

Table 3

Table 4

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分组 Group	脑干 Brainstem	丘脑及基底节 Thalamus and basal ganglia	额叶 Frontal lobe	顶叶 Parietal lobe	颞叶 Temporal lobe	枕叶 Occipital lobe	大脑半球 Cerebral hemisphere	小脑半球 Cerebellar hemisphere
血糖正常组 Normal glucose group (n=330)	48(14.5)	154(46.7)	40(12.1)	18(5.5)	20(6.1)	12(3.6)	20( 6.1)	18( 5.5)
应激性高血糖组 Stress hyperglycemia group (n=56)	10(17.9)	18(32.1)	6(10.7)	4(7.1)	4(7.1)	0	8(14.3)	6(10.7)
χ²	0.206	2.044	0.045	0.127	0.048	1.051	2.407	1.136
P	0.650	0.153	0.832	0.722	0.826	0.305	0.121	0.287

分组 Group	认知正常 Normal cognitive function (n=152)	轻度认知障碍 Vascular mild cognitive impairment (n=196)	痴呆 Vascular dementia (n=74)
血糖正常组 Normal glucose group(n=360)	140(38.89)	166(46.11)	54(15.00)
应激性血糖轻度升高组 Stress blood glucose increased slightly(n=40)	10(25.00)	18(45.00)	12(30.00)
应激性血糖显著升高组 Stress blood glucose increased obviously(n=22)	2( 9.09)	12(54.55)	8(36.36)

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