HbA1c水平与脑出血合并糖尿病患者的迟发性脑水肿的相关性研究-现代医学

HbA1c水平与脑出血合并糖尿病患者的迟发性脑水肿的相关性研究

单位：张家港市中医医院外三科, 江苏张家港 215600

分类号：R364.19

出版年·卷·期（页码）：2019·47·第一期（29-33）

摘要：

目的：探讨糖化血红蛋白（HbA1c）水平与脑出血合并糖尿病患者的迟发性脑水肿的相关性。方法：回顾性分析2012年1月至2017年10月在我院治疗的70例脑出血合并糖尿病患者的临床资料，按照患者的HbA1c水平分为两组，HbA1c≤8%为HbA1c正常组（n=35），>8%为HbA1c异常组（n=35），并且按照患者是否发生迟发性脑水肿分为未发生迟发性脑水肿组（n=50）和发生迟发性脑水肿组（n=20），探讨HbA1c水平、血肿体积、美国国立卫生研究量表（NIHSS）评分和格拉斯哥昏迷量表（GCS）评分与脑出血合并糖尿病患者迟发性脑水肿的相关性。结果：HbA1c正常组NIHSS评分低于HbA1c异常组，血肿体积小于HbA1c异常组，GCS评分数值大于HbA1c异常组，差异均有统计学意义（P<0.05）。脑出血合并糖尿病患者的HbA1c与NIHSS评分、血肿体积均呈正相关，与GCS评分呈负相关（均P<0.05）。HbA1c正常组中3例发生迟发性脑水肿（8.57%），HbA1c异常组中17例发生迟发性脑水肿（48.57%），两组比较差异具有统计学意义（χ²=13.720，P<0.05）；HbA1c异常组患者发生迟发性脑水肿的严重程度大于HbA1c正常组患者，差异有统计学意义（Z=2.835，P<0.05）。未发生迟发性脑水肿组NIHSS评分、HbA1c水平低于发生迟发性脑水肿组患者，血肿体积小于发生迟发性脑水肿组，GCS评分大于发生迟发性脑水肿组，差异均有统计学意义（P<0.05）。结论：HbA1c水平较高的糖尿病患者脑出血后出现迟发性脑水肿的概率及严重程度均较高，NIHSS评分、GCS评分、血肿体积及HbA1c水平可以作为推测脑出血合并糖尿病患者发生迟发性脑水肿概率的根据。

Objective: To investigate the correlation between HbA1c level and delayed cerebral edema in cerebral hemorrhage patients complicated with diabetes mellitus. Methods:The clinical data of 70 cerebral hemorrhage patients complicated with diabetes mellitus treated in our hospital from January 2012 to October 2017 were retrospectively analyzed. According to the levels of HbA1c,the patients were divided into two groups: ≤ 8% was HbA1c normal group (n=35), and >8% was HbA1c abnormal group (n=35). According to whether developing to delayed cerebral edema, the patients were divided into no delayed cerebral edema group (n=50) and delayed cerebral edema group (n=20). The relationship between HbA1c level, hematoma volume, National Institute of Health Research (NIHSS) score and Glasgow Coma Scale (GCS) score and delayed cerebral edema in the patients with cerebral hemorrhage complicated with diabetes were investigated. Results:The NIHSS scoreof HbA1c normal group were lower than that of HbA1c abnormal group, hematoma volume in was smaller than that of HbA1c abnormal group,and the GCS score was higher than that of HbA1c abnormal group, and the difference was statistically significant (all P<0.05). HbA1c was positively correlated with NIHSS score and hematoma volume in cerebral hemorrhage patients complicated with diabetes, and negatively correlated with GCS score (all P<0.05). Three patients in the normal HbA1c groupoccurred delayed cerebral edema(8.57%), and 17 patients in abnormal HbA1c groupoccurred delayed cerebral edema (48.57%). The difference was statistically significant (χ²=13.720,P<0.05). Delayed cerebral edema in the HbA1c abnormal group was more seriousthan that of normal HbA1c group (Z=2.835, P<0.05). The NIHSS score, HbA1c level in patients withnodelayed cerebral edema were lower than those in patients with delayed cerebral edema,and hematoma volume was smaller than that in patients with delayed cerebral edema.The GCS score was higher than that in patients with delayed cerebral edema. The difference was statistically significant (P< 0.05).Conclusion: In patients with high HbA1c levels, the probability and severity of delayed cerebral edema after cerebral hemorrhage are higher. NIHSS score, GCS score, hematoma volume and HbA1c level can be used as a basis for presuming the probability of delayed cerebral edema in cerebral hemorrhage patients complicated with diabetes.

参考文献：

[1] 王克英,崔甍甍,张进军,等.气象因素对脑血管疾病急性发病影响的病例交叉研究[J].中国全科医学,2015,12(22):2662-2666.
[2] 官念,吴碧华,刘黎明,等.脑出血病因及相关机制的研究进展[J].中华老年心脑血管病杂志,2016,18(6):670-672.
[3] 刘兴宇,甄艳凤,崔建忠,等.高血压合并糖尿病患者脑出血后迟发性脑水肿与血清 MMP-9水平的关系[J].山东医药,2017,57(2):63-65.
[4] 周春亭,王朝晖.脑出血后发生迟发性脑水肿的相关危险因素分析[J].卒中与神经疾病,2016,23(2):91-93.
[5] 刘兴宇,甄艳凤,崔建忠,等.糖化血红蛋白对高血压脑出血合并糖尿病患者预后及MMP-9的影响[J].广东医学,2016,37(19):2947-2949.
[6] 黄江玲,邱少雄,肖亮生,等.D-二聚体和糖化血红蛋白对脑小血管病严重程度的预测价值[J].实用医学杂志,2015,31(3):401-403.
[7] 刘兴宇,甄艳凤,崔建忠,等.HbA1c水平与脑出血合并糖尿病患者迟发性脑水肿的相关性研究[J].中国现代医学杂志,2017,27(10):94-97.
[8] 王薇,钟堃,何法霖,等.我国糖化血红蛋白参考区间和切值调查与分析[J].中华糖尿病杂志,2014,6(12):859-863.
[9] 蔡业峰,贾真,张新春,等.美国国立卫生院卒中量表(NIHSS)中文版多中心测评研究——附537例缺血中风多中心多时点临床测评研究[J].北京中医药大学学报,2008,31(7):494-498.
[10] 王小刚,高丁,李涛,等.院前应用格拉斯哥昏迷分级评分评估颅脑损伤患者与预后的相关性分析[J].中国临床医生杂志,2015,12(8):36-39.
[11] 张冠妮,杨友松.脑出血患者血清基质金属蛋白酶-9、细胞纤维连接蛋白变化及其相关性研究[J].实用医院临床杂志,2015,12(4):15-17.
[12] 洪浩敏,陈松深,邱浩强,等.脑钠肽与脑出血部位、出血量及脑出血后低钠血症的相关性研究[J].重庆医学,2016,5(3):403-405.
[13] 卞合涛,初建峰.地塞米松对脑出血后脑水肿的影响及可能机制[J].中国老年学杂志,2016,36(12):2921-2922.
[14] LIN X,TANG Y,SUN B,et al.Cerebral glucose metabolism:influence on perihematomal edema formation after intracerebral hemorrhage in cat models[J].Acta Radiol,2010,51(5):549-554.
[15] 马亚峰,冯海翔.急性脑出血患者初次血糖、糖化血红蛋白A1c及血氨水平联合测定的临床分析[J].现代检验医学杂志,2007,22(4):75-76.

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