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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
作者:闻峰  陆明  郭春华 
单位:张家港市中医医院 外三科, 江苏 张家港 215600
关键词:脑出血 糖尿病 糖化血红蛋白 迟发性脑水肿 
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.

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