The Analysis Of The Relationship Between Impaired Glucose Regulation And Prognosis Of Ischemic Cerebrovascular Disease

ObjectiveIschemic serebral vascular disease is one of the common diseases in the middle and older population, characteristic by high morbidity,high disability,high mortality and high recurrence rate and seriously threaten the health and living quality and cause immense societal burden.As is well-known,there are multiple risk factors relation to ischemic cerebral vascular disease,such as age, hypertension, hyperlipaemia, arteriosclerosis, smoke etc and hyperglycemia is a very important risk factor among of them.Among the stroke patients,hyperglycemia exists commonly,no matter ischemic stroke or hemorrhagicapoplexy.Baird dtc discovered by research that over 2/3 of chronicity stroke patients and over 1/3 of acute stroke patients could combine hyperglycemia(BS>6.0mmol/L).Hyperglycemia not only cause the incidence of stroke rising,but also influence the prognosis of stroke,and correlate the recurrence of stroke..Hyperglycemia conclude impaired glucose reglution,diabetes mellitus and stress hyperglycemia.Along with constantly going deep into the reaearch on the incidence of diabetes mellitus,the perniciousness to heart brain organ disorders of diabetes mellitus and the diabetes mellitus's standard of diagnosis,more and more attention was paied to impaired glucose regulation.Impaired glucose regulation conclude impaired fasting glucose and impaired glucose tolerance.Moreover,many studies had stated that although IGR was still in the phase of pre-diabetes,it has had the same metabolic characters as DM,and the morbidity and mortality of vascular events was much higher than that of normal glucose regulation.But up to now,few studies about the prevalence of IGR in the ischemic cerebral disease had been seen and the relationship of ischemic cerebral disease and IGR had been disputed.Based on above all, we observe the prevalence of impaired glucose regulation (IGR)in non-diabetic ischemic cerebral vascular disease patients and to research whether consider IGR as an independent risk factor to prognosis of cerebral infarction.MethodsBetwween Junuary 2008 and June 2009,all acute ischemic cerebrovascular disease patients without prior diagnosis of diabetes mellitus of Department of Cerebrovascular disease,Third peoples'Hospital of Jinan were enrolled to screen. All patients were detected FPG and 2h glucose level and reexamined the patients'FPG and 2h glucose level.Except the patients who suffered diabetes mellitus,who had an injury or an operation within 3 months,who had an infection,who had stress hyperglycemia,there were 99 inpatients to be bringed into the study. Their clinical information,including the age, sex, smoking and drinking and their comorbidities information,including hypertension, hyperlipidemia, coronary heart disease, carotid stenosis, hyperfibrinogenemia and hyperhomocysteinemia also were recorded. And repeat OGTT after three months to determine IGR or stress hyperglycemia..According to the results of FPG and OGTT 2h blood glucose level, the subjects were classified into IGR group (5.6mmol/l≤FPG≤6.9mmol/l and/or 7.8mmol/l≤OGTT2h glucose level<11.1mmol/l) and NGR group (FPG< 5.6mmol/l and OGTT2h glucose level<7.8mmol/l).Recorded National Institutes of Health Stroke Scale,Barthel index and modified Rankin Scale at first week after stroke, follow-up visited after one,three months and recorded Barthel index,modified Rankin Scale and incidents such as recurrence,death and other vascular incidents among the 3 months.We observe the prevalence of impaired glucose regulation. First,devided all the patients into two groups by the median of NIHSS grades. Compaired the incidence rates of progressivity stroke. Then all patients were devided into NGR group and IGR group, analised the serious level and prognosis of the two groups.Multiple Logistic regression analysis were used to evaluate the associations between the risk factors.ConclusionGenerally,120 ischemic cerebral disease inpatients were screened and 99 inpatients were bringed into the study.Through FPG alone,among the 120 patients we found 20 patients with increased FPG level and 100 patients without, including DM 5 person, IFG 14 persons and stress hyperglycemia 1 person. Depending on OGTT,we found 27 patients have abnormal have abnormal 2h glucose level, including DM 7 person(2 person also have abnormal FPG), IGT 22 persons (4 person also have abnormal FPG) and stress hyperglycemia 2 persons.The prevalence of IGR and DM were 26.7%(32/120) and 10%(12/120).Compared the difference of two detecting methods, namely alone FPG and OGTT. We could found that 5 DM patients,18 IGT patients and 2 stress hyperglycemia patients were missed.The missed diagnosis rates was 20.8%(25/120) of all the patient and 25%(25/100) of the patients having normal FPGThe prevalence of IGR was 32.3%.After deviding the patients into two groups by NIHSS grades, compared the two groups could found the prevalence of IGR of NIHSS>6 group is higher than NIHSS <6 group, the differences were statistically significant. NIHSS was used to evaluated the severity of cerebral infarction.Compared with NGR group 3.5(0-17),the IGR 6(0-23) have higher scores of NIHSS, the differences were statistically significant.On the other hand,at 1st month,3rd month after cerebral infarction,the rates of bad prognosis of the patients with IGR(40.6% and 25.0%) were higher than patients with NGR (13.4% and 5.97%),the differences were statistically significant.IGR is an independent risk factor for ischemic cerebral vascular disease.(OR value and P value:4.121,0.035.).