Study On The Association Between Abnormal Glucos Emetabolism And Progressive Ischemic Stroke

Objective:To explore the relationship between abnormal glucose metabolism ind progressive ischemic stroke.Methods:The inpatients with acute ischemic stroke were consecutively collected, and divided into progressive ischemic stroke group and non-progressive ischemic stroke group. They were admitted to the department of neurology of the First Affiliated Hospital of Henan University of Science and Technology from October 2013 to September 2014. The classifications of glucose metabolism included diabetes mellitus, impaired glucose regulation and normal glucose metabolism in the patients with acute ischemic stroke by diagnostic criteria of diabetes association in 2010. The etiologic types of acute ischemic stroke were classified into five subtypes including atherothrombosis, small artery disease, cardioembolism, stroke of other determined etiology and stroke of undetermined etiology by modified TOAST type (known as NEW-TOAST type). All the data was analyzed by SPSS 16.0.Results:1.350 cases of inpatients with acute ischemic stroke were incorporated. [30(37.1%) cases were progressive ischemic stroke.26.4% of patients with progressive ischemic stroke occurred within 6-24 hours, and 92.2%of whom occurred within one week.2. There were no significant differences in the age, gender, body mass index, >revious history (history of hypertension, history of coronary heart disease, smoking habit and drinking habit), the NIHSS scores on admission and biochemical indexes (triglyceride, total cholesterol and homocysteine) between two groups (P>0.05). However, there were significant differences in the fasting blood glucose next day on admission, glycosylated hemoglobin, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and previous diabetes between two groups (P<0.05).3. The related risk factors of progressive ischemic stroke were analyzed by the non-conditional logistic regression. The results showed that five indexes of them had statistically significance such as fasting blood glucose next day on admission (OR .380), glycosylated hemoglobin (OR 1.639), previous diabetes (OR 1.536), LDL-C (OR 1592), and HDL-C (OR 0.669).4. There were 91 cases (70%) with abnormal glucose metabolism in the PIS group, ind 36 cases (27.7%) were previous diabetes. OGTT was available for 94 cases who had no history of diabetes. The results of OGTT showed that 4 cases (3.1%) were ewly diagnosed diabetes, and 51 cases (39.2%) were impaired glucose regulation. There were 128 cases (57.4%) with abnormal glucose metabolism in the NPIS group, nd 39 cases(25.4%) were previous diabetes. OGTT were available for 181 cases who ad no history of diabetes. The results of OGTT showed that 34 cases (15.5%) were ewly diagnosed diabetes, and 55 cases (25.0%) were impaired glucose regulation.The revalence of abnormal glucose metabolism had significant differences between two groups (x2= 4.873, P= 0.027, odds ratio was 1.677, and 95% confidence interval was (1.058-2.659). Impaired glucose regulation had highest morbidity (39.2%) in the PIS group.5. The AT and SAD were main subtypes by NEW-TOAST in the two groups. In addition, the AT had highest ratio among different subtypes in the PIS group, but it was the SAD in the NPIS group. There were significant differences in the distribution of ifferent subtypes by NEW-TOAST between two groups (x2=21.560,P=0.000).6. There was a correlation between different levels of glucose metabolism and different subtypes by NEW-TOAST in the PIS group (x2=17.904,P=0.006,r=0.256) or NPIS group (x2=15.186,P=0.017,r=0.024).7. There were respectively significant differences in the abnormal glucose metabolism of the AT (x2=11.078,P=0.001) and SAD (x2=11.078,P=0.001) between two groups. The main abnormal glucose metabolism of the AT was impaired glucose regulation in the PIS group, but that of the SAD was diabetes.Conclusion:1. Progressive ischemic stroke were significantly associated with previous diabetes, high fasting blood glucose next day on admission and high glycosylated hemoglobin which were independent risk factors of progressive ischemic stroke.2. The patients of ischemic stroke with abnormal glucose metabolism were more likely to develop into progressive ischemic stroke. After acute ischemic stroke, the incidence rate of progressive ischemic stroke in the patients with abnormal glucose metabolism was 1.677 times that of the patients with normal glucose metabolism.3. Impaired glucose regulation may be one of the risk factors of progressive ischemic stroke. Only detecting fasting blood glucose, most of abnormal glucose metabolism would be missed.4. The AT was main etiologic subtype of NEW-TOAST in the progressive schemic stroke group, and there was a correlation between levels of abnormal glucose regulation and different subtypes of NEW-TOAST. Impaired glucose regulation was common in the AT of progressive ischemic stroke, but it was diabetes in the SAD of progressive ischemic stroke.