急性缺血性卒中NEW-TOAST分型各亚型与血糖的关系

摘要

目的 研究急性缺血性卒中NEW-TOAST分型各亚型与血糖的关系。方法 回顾性分析624例住院急性缺血性卒中患者的病史及相关检查结果，按NEW-TOAST分型标准对所有患者进行分型，并对各亚型的血糖水平分布资料进行多分类资料的关联分析，比较各亚型糖代谢异常及糖化血红蛋白异常的频率，然后计算血糖、血压和血脂的优势比（OR）及95％的置信区间(CI)。结果 (1) 624例患者NEW-TOAST分型中，以动脉粥样硬化血栓形成型(AT)为主，小动脉闭塞型(SAO)次之；其中原有糖尿病病史119例(19.1％)，新发现糖尿病40例(7.5％)，糖调节受损71例(11.4％)；(2)AT、SAO患者糖代谢异常及糖化血红蛋白的比例均较高，分别为40.4％、39.7％及48.6％、48.1％；各亚型与高血糖的关联分析，x2=14.83，P=0.020，r=0.152。SAO患者高血糖的OR为1.925,95％ CI 1.392 ～2.664,AT患者与高血糖无明显相关；AT患者高血压的OR为2.874，95％ CI1.957 ～4.222，SAO患者高血压的OR为1.609，95％ CI 1.100 ～1.235；各亚型与高低密度脂蛋白胆固醇(LDL-C)的关联分析，SAO患者高LDL-C的OR为1.419,95％CI1.026 ～ 1.962,AT与高LDL-C无明显相关；(3)各亚型糖代谢异常频率差异的比较：x2=17.79,P=0.000，AT及SAO分别与其他3型相比，均P＜0.05;而各亚型糖化血红蛋白异常频率差异的比较：x2=35.57，P=0.000，两两比较发现，AT与SAO，x2=0.014,P=0.906；AT及SAO分别与其他3型相比，均P＜0.05。结论 急性缺血性卒中NEW-TOAST分型中以AT、SAO所占比例更高；各亚型与血糖水平有关联性，且SAO与血糖关联最为密切；高血压对大小血管均有损伤作用，高LDL-C可能对小血管的损伤较明显。%Objective To investigate the relation between each subtype of cerebral ischemic stroke classified by NEW-TOAST criteria and the levels of blood sugar. Methods A retrospective study in 624 patients hospitalized with acute cerebral ischemic stroke. All the patients were classified using NEW-TOAST classification standard. Blood glucose in patients with different stroke subtypes was recorded, and analyzed for the incidence of abnormal glucose metabolism in each subtype. The correlation of glucose to blood sugar,blood pressure and blood fat was analyzed using odd ratio (OR) and 95％ confidence intervals (CI).Results(1) Among 624 patients, the most common stroke subtype by NEW-TOAST classificationis atherothrombosis (AT), followed by small arterial occlusion (SAO). One hundred and nineteen patients (19. 1％ ) had diabetes history; another 40 patients(7.5％ ) were newly diagnosed with diabetes in this study; and 71 patients ( 11.4％ ) were found to have glycoregulation abnormality. The incidence of abnormal glycometabolism was high in patients with AT ( 40. 4％ ) and SAO ( 39. 7％ ). ( 2 ) Association analysis between stroke subtypes and blood sugar: x2 =14. 83,P =0. 020, r =0. 152; in SAO patients, OR was 1. 925 (95％ CI 1. 392-2. 664) ; in the patients with AT, there was no correlation to blood sugar levels.Association analysis of high blood pressure in stroke subtypes: in AT patients, OR was 2. 874 (95％ CI 1. 957-4. 222) ; in SAO, OR was 1. 609 (95％ CI 1. 100-1. 235). Association analysis of high LDL-C in each subtype: OR in SAO was 1.419 (95％ CI 1.026-1. 962) ;No significant correlation of LDL-C in AT patients, P =0. 929 ; (3) There is significant difference of frequency of abnormal glycometabolism between stroke subtypes: x2 =17. 79 ,P =0. 000; between AT and SAO patients, x2 =0. 024,P =0. 877; between AT or SAO patients to other three subtypes, P ＜ 0. 05. Conclusions Among the subtypes of cerebral ischemic stroke by NEW-TOAST classification, AT and SAO are the most common subtypes. All the subtypes have correlation to the high level of blood sugar, and SAO has the highest correlation to blood sugar levels. High blood pressure may affect both large vessels and small vessels, while high LDL-C may mainly affect small vessels.