| Objective:Monitored the Glucose Fluctuations by Continuous Glucose Monitoring system( CGMS) for patients with type 2 diabetes mellitus(T2DM)with acute cerebral infarction(ACI) who received thrombolytic therapy,observe the thrombolytic effect and prognosis,to observe the relationship of Glucose fluctuations on effect and prognosis after thrombolytic therapy of patients with ACI who had T2 DM.Methods:A total of 83 patients with T2 DM with ACI who recieved thrombolytic therapy with alteplase at General Hospital of Beijing Military Command from August 2013 to November 2014 were enrolled retrospectivrly.They were divided into two groups by whether they had T2DM:type 2 diabetes mellitus with acute cerebral infarction(DMCI) group(n=47),non-type 2 diabetes mellitus with cerebral infarction(NDMCI) group(n=38).And according to the mean amplitude of glycemic excursions(MAGE) divided the patients into two groups:high MAGE group(n=45),normal MAGE group(n=36).DMCI and NDMCI group is divided into two subgroups on the basis of MAGE,high DMCI-MAGE group(n=33),normal DMCI-MAGE group(n=14);high NDMCI-MAGEgroup(n=12),normal NDMCI-MAGE group(n=24).We collected general clinical and biochemical data after patients admitted to hospital,and the thromboxane A2(TX-A2) and high-sensitivity C-reactive protein(hs-CRP) levels were detected.The national institutes of health stoke scale(NIHSS) score was collected atadmission and after 24 hours of thrombolysis for patients,monitor the cerebral hemorrhage and recanalization,and collected Modified Rankin Scale(MRS) score to evaluate their prognosis.Statistics were analyzed by the statistical software SPSS 20.0.Results:1.Compared with DMCI group and NDMCI group on admission, Fasting plasma glucose(FPG),hemoglobin A1c(Hb A1c),systolic pressure(SBP),Triglyceride(TG),low density lipoprotein cholesterol( LDL-C),TXA-2,hs-CRP were statistically significant(P<0.05).Compared with high MAGE group and normal MAGE group on admission, the percentage of patients with a history of diabetes,the percentage of patients with a history of hypertension,FPG,Hb A1 C,SBP,diastolic pressure( DBP),TG,high density lipoprotein cholesterol(HDL-C),LDL-C,TXA-2,hs-CRP were statistically significant(P<0.05).2.DMCI group patients the 24 h mean of blood glucose(MBG),Blood Glucose Standard Deviation(SDBG),Mean Amplitude of Plasma Glucose Excursions(MAGE),absolute means of daily differences(MODD),The time percentage of blood glucose greater than or equal to 7.8mmol/L(PT7.8),The time percentage of blood glucose is less than or equal to 3.9mmol/L(PT3.9) were all high than NDMCI group patients,The difference was statistically significant.The hs-CRP,TX-A2 catecholamine levels are associated with MAGE.3.Comparison of NIHSS score before and after thrombolytic therapy between DMCI group and NDMCI group.Compared with DMCI group and NDMCI group,the difference of NIHSS score was statistically significant for 24 hours after thrombolysis.Compared with the NIHSS score before and after thrombolysis in group NDMCI, the difference was statistically significant(P=0.040).Comparison of NIHSS score before and after thrombolytic therapy between high MAGE group and normal MAGE group.In normal MAGE group,the difference of NIHSS score was statistically significant for 24 hours after thrombolysis..Compared between high MAGE group and normal MAGE group,There were statistically significant differences in NIHSS score for 24 hours after thrombolysis(P=0.000).4.The analysis of correlation was made between NIHSS scores for 24 hours after thrombolysis and related factors,the difference had statistical significance between Hb A1 c,MAGE,SDBG,MODD,PT7.8,PT3.9,FPG,hs-CRP,TXA2,TIMI score and NIHSS scores for 24 hours after thrombolysis(P<0.05).5.During follow-up,in DMCI group,the occurrence of hemorrhagic transformation were4 cases(8.51%),good recanalization were 17 cases(36.17%), poor prognosis(90 d m RS score≥2)were 26 cases(55.32%);in NDMCI group,the occurrence of hemorrhagic transformation were 1 cases(2.78%),good recanalization were 25 cases(69.44%),poor prognosis(90 d m RS score≥2)were 12 cases(33.34%).there was statistical difference in the recanalization after thrombolysis and prognosis between two groups(P<0.05).The cases of cerebral hemorrhage transformation were less,need to increase the number of cases to continue to observe.During follow-up,in high MAGE group,the occurrence of hemorrhagic transformation were 4 cases(8.89%),good recanalization were 15 cases(33.33%),poor prognosis(90d m RS score≥2)were 31 cases(68.89%);in normal MAGE group,the occurrence of hemorrhagic transformation were 1 cases(2.07%),good recanalization were 27 cases(71.05%),poor prognosis(90 d m RS score≥2)were 7 cases(18.42%).There was statistical difference in the recanalization after thrombolysis and prognosis between two groups(P<0.05).The cases of cerebral hemorrhage transformation were less,need to increase the number of cases to continue to observe.6.The comparison of the Prognosis between the subgroups of DMCI group and NDMCI group during follow-up.High DMCI-MAGE group were 33 cases,normal DMCI-MAGE group were 14 cases;High NDMCI-MAGE group were 12 cases,normal NDMCI-MAGE group were 24 cases. In high DMCI-MAGE group,poor prognosis were23 cases(69.70%);poor prognosis were 3 cases(21.43%)in normal DMCI-MAGE;There was significant difference between two groups(P=0.006).In high NDMCI-MAGE group,poor prognosis were 8 cases(66.67%);poor prognosis were 4 cases(16.67%)in normal NDMCI-MAGE;There was significant difference between two groups(P=0.009).7.The logistic regression analysis for prognosis of patients.The 90 days m RS scoreof patients as the dependent variable,Hb A1 c,MAGE etc.related factors as independent variables,made Logistic regression analysis.The result is 24 hours NIHSS score after the thrombolytic treatment,Hb A1 c,MAGE enter the final equation,the Logistic regressionmodel is:-10.976+1.297*The 24 h NIHSS score after thrombolysis+1.196*Hb A1c+0.401*MAGE.According to the model,The 24 h NIHSS score after thrombolysis,Hb A1 c,MAGE may be the important factors influencing the prognosis of patients.Conclusions:1.Compared with the ACI patients without T2 DM,the ACI patients with T2 DM have greater glucose fluctuation,poor recovery of neurological function at 24 hours after thrombolysis,and hemorrhagic transformation is easy to occur,the prognosis is poor.2.Compared with the ACI patients with normal glucose fluctuation,the ACI patients with greater glucose fluctuation have poor recovery of neurological function at 24 hours after thrombolysis,and hemorrhagic transformation is easy to occur,the prognosis is poor.3.T2 DM with ACI patients have higher TX-A2,hs-CRP,and the higher more obviously at the time of great glucose fluctuation, prompt glucose fluctuation is relate to the prethrombotic state,inflammatory reaction,participate in the pathogenesis of acute cerebral infarction.4.Whether the patients have clear history of diabetes mellitus,great glucose fluctuation may be one of the important risk factors for the poor prognosis of ACI patients. |
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