Objective To observe the effect of blood glucose (FPG) and glycosylated hemoglobin (HbA1c) level on intravenous thrombolysis in patients with acute cerebral infarction complicated with type 2 diabetes mellitus .Methods From January 2015 to December 2016 , in our hospital , admissions of 96 patients with acute cerebral infarction were given alteplase ( Recombinant tissue plasminogen activator , rt-PA) for thrombolytic therapy study were enrolled , patients were divided into acute cerebral infarction patients with type 2 diabetic group ( DMCI group ) with 50 cases and acute cerebral infarction and non-type 2 diabetes group (NDMCI group) with 46 cases.Using neurological deficit (NIHSS) score, modified Rankin Scale (MRS) score, Barthel index score of patients and determining the patient FPG , glycosylated hemoglobin (HbA1c), triglycer-ide ( TG) , low density lipoprotein cholesterol ( LDL-C) , TC, high density lipoprotein cholesterol ( HDL-C) and other indica-tors , observed DMCI patients before thrombolysis random blood glucose level and HbA 1c value 24h efficacy of thrombolysis;patients were followed up for 3 months after thrombolysis .Results (1) In DMCI group compared with NDMCI group , FPG, HbA1c TG, LDL-C, the difference was statistically significant between two groups (compared within DMCI group:t =2.942, t =6.044, t =2.631, t =8.825;compared within NDMCI group:t =9.223, t =25.178, t =5.343, t =4.731;after treat-ment:t =11.365, t =11.051, t =6.380, t =3.258,all P <0.05).The 2 groups after treatment, the differences of TC, HDL-C were not statistically significant ( t =1.306, t =1.904; P >0.05); (2) In DMCI group 24 h average blood (MBG), SDBG and MAGE were higher than NDMCI group patients [(8.4 ±2.8) mmol/L vs.(5.6 ±1.8) mmol/L, (3.0 ± 0.3) mmol/L vs.(2.2 ±0.4) mmol/L, (4.4 ±0.8) mmol/L vs.(3.6 ±0.5) mmol/L, t =5.772, 11.142, 5.816, P <0.05];(3) Before thrombolysis blood glucose <6.0 mmol/L, 24 h after thrombolysis were the lowest (28.6%), and blood glucose before thrombolysis in 7-9 mmol/L, 24 h after thrombolysis had the highest efficiency (70.6%);(4) Increased grad-ually with the value of HbA1c, 24 h after thrombolysis has low efficiency gradually .The highest value (62.5%) at HbA1c <6.0 mmol/L, and the HbA1c value was more than 7 mmol/L with the lowest (28.6%);(5) After thrombolysis in the DMCI group, NIHSS, MRS score of patients were higher than in NDMCI group , while the Barthel index in patients with DMCI group was lower than that of NDMCI group ( P <0.05); (6) DMCI intracranial hemorrhage after thrombolysis group was higher than that of NDMCI group, but the difference was not significant (χ2 =1.132, P >0.05), but there were significant differ-ences in vascular recanalization and prognosis (χ2 =10.816,χ2 =7.739, P <0.05).Conclusion Thrombolytic therapy in patients with type 2 diabetes mellitus in the acute cerebral infarction , blood glucose levels affect the efficacy of HbA 1c , the higher the value , the effect is worse , and the blood glucose control before thrombolysis in 7-9 mmol/L is helpful to improve the curative effect of intravenous thrombolytic therapy .%目的：观察急性脑梗死合并2型糖尿病患者血糖（ FPG）和糖化血红蛋白（ HbA1c ）水平对静脉溶栓效果的影响。方法选择2015年1月—2016年5月佛山市第五人民医院神经内科接诊的急性脑梗死患者96例作为研究对象。将患者按是否合并糖尿病分为急性脑梗死合并2型糖尿病组（ DMCI组）50例和急性脑梗死未合并2型糖尿病组（NDMCI组）46例，患者均使用注射用阿替普酶进行溶栓。采用神经功能缺损（ NIHSS）评分、改良Rankin量表（MRS）评分、Barthel指数对患者评分，并测定患者FPG、HbA1c、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）等指标，观察DMCI组患者溶栓前随机血糖、HbA1c对溶栓后24 h疗效；同时追踪患者统计溶栓3个月后病死率。结果（1） DMCI组治疗后的FPG、HbA1c、TG、LDL-C与NDMCI组比较，差异具有统计学意义（ t ＝11．365、11．051、6．380、3．258， P均＜0．05）；而2组治疗后TC、HDL-C比较，差异无统计学意义（ t ＝1．306、1．904；P ＞0．05）。（2）DMCI组患者的24 h平均血糖（MBG）、血糖水平标准差（SDBG）、平均血糖波动幅度（MAGE）均比NDMCI组患者高[（8．4±2．8）mmol／L vs．（5．6±1．8）mmol／L，（3．0±0．3）mmol／L vs．（2．2±0．4） mmol／L，（4．4±0．8）mmol／L vs．（3．6±0．5）mmol／L， t ＝5．772、11．142、5．816， P ＜0．05]。（3）溶栓前血糖＜6．0 mmol／L时，溶栓后24 h 有效率最低（28．6％），而溶栓前血糖在7．0～9．0 mmol／L 时，溶栓后24 h 有效率最高（70．6％）。（4）随着HbA1c值的逐渐升高，溶栓后24 h有效率逐渐低，在HbA1c值＜6．0 mmol／L时最高（62．5％），而在HbA1c值≥7．0 mmol／L时最低（28．6％）。（5）溶栓后DMCI组患者的NIHSS、MRS评分均高于NDMCI组患者，而Bar-thel指数低于NDMCI组患者（ P ＜0．05）。（6） DMCI 组溶栓后颅内出血率高于 NDMCI 组，但差异不显著（χ2＝1．132， P ＞0．05），而在血管再通以及预后上存在显著差异（χ2＝10．816，7．739， P ＜0．05）。结论在急性脑梗死合并2型糖尿病的静脉溶栓的治疗中，血糖水平影响着疗效，HbA1c值越高，疗效越差，而溶栓前将患者血糖控制在7．0～9．0 mmol／L有助于提高静脉溶栓的疗效。
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