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《Chinese Journal of Difficult and Complicated Cases》 2017-01
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Acute cerebral infarction patients with type 2 diabetes,blood glucose,glycosylated hemoglobin levels of intravenous thrombolytic therapy effects

LU Shaohuan;ZHANG Jing;CHENG Wanchun;LI Zhipeng;Department of Neurology,Foshan Fifth People's Hospital,Guangdong Province;  
Objective To observe the effect of blood glucose(FPG) and glycosylated hemoglobin(HbA,,.) level on intravenous thrombolysis in palienls with acute cerebral infarction complicated with type 2 diabetes mellitus.Methods From January 2015 to December 2016.in our hospital,admissions of%palienls with acute cerebral infarction were given alleplase(Recombinant tissue plasminogen activator,rt-PA) for thrombolytic therapy study were enrolled,palienls were divided into acute cerebral infarction palienls with type 2 diabetic group(DMCI group) with 50 cases and acute cerebral infarction and non-type 2 diabetes group(NDMCI group) with 46 eases.Using neurological deficit(MUSS) score,modified Kaukiii Scale i MliS) score,Harihel index score of palienls and determining the patient FPG,glycosylated hemoglobin(111 yV,),triglyceride(TC),low density lipoprotein choleslerol(LDL-C),TC,high density lipoprotein cholesterol(IIDI.-C) and other indicators,observed DMCI patients before thrombolysis random blood glucose level and 1111 \,.value 24 h efficacy of thrombolysis;patients were followed up for 3 months after thrombolysis.Results(1) In DMCI group compared with NDMCI group,FPG,HbA_(1c),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 treatment;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 gradually with the value of HbA_(1c),24 h after thrombolysis has low efficiency gradually.The highest value(62.5%) at HbA_(1c) 6.0 mmol/L,and the HbA_(1c) 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(x~2 = 1.132,P 0.05),but there were significant differences in vascular recanalization and prognosis(x~2 = 10.816,x~2 =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.
【Fund】: 2016年度佛山市卫生和计划生育局医学科研课题(20160116)
【CateGory Index】: R743.33;R587.1
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