应激性高血糖比率与前循环穿支动脉硬化性脑梗死早期认知功能障碍的相关性研究

王静悦; 孙博; 彭延波; 柴海霞; 范海燕; 边哲

doi:10.16766/j.cnki.issn.1674-4152.001947

应激性高血糖比率与前循环穿支动脉硬化性脑梗死早期认知功能障碍的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.001947

1.
华北理工大学附属医院神经内科，河北唐山 063000
2.
唐山市第二医院创伤三科，河北唐山 063000

基金项目:

河北省医学科学研究课题计划 20201238

详细信息

通讯作者:
彭延波，E-mail：shuangshuang08304@163.com

中图分类号: R743.33 R749.13
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出版历程
- 收稿日期: 2020-07-02
- 网络出版日期: 2022-02-16

Correlation between stress hyperglycaemia ratio and early cognitive dysfunction in patients with anterior circulation perforator arteriosclerotic cerebral infarction

1.
Department of Neurology, North China University of Science and Technology Hospital, Tangshan, Hebei 063000, China

摘要

摘要: 目的探讨应激性高血糖比率对前循环穿支动脉硬化性脑梗死早期认知功能障碍发生的影响。方法选取2014年12月—2019年12月在华北理工大学附属医院神经内科住院治疗的前循环穿支动脉硬化性脑梗死患者为观察对象，根据发病90天MoCA评分对所有入组患者分组，将完成认知评定的332例患者分为认知功能障碍组(145例)和认知功能正常组(187例)，分析应激性高血糖比率SHR与90天MoCA评分、MMSE评分的相关性，并绘制ROC曲线评价应激性高血糖相关指标对预测认知障碍的效能。结果本研究中早期认知障碍发生率为43.67%，单因素分析示2组的年龄、高血压病史、糖尿病史、文化程度、入院NIHSS评分、入院随机血糖、SHR差异有统计学意义。多因素logistic回归分析示年龄(OR=1.144, 95%CI: 1.097~1.193, P＜0.001)、入院NIHSS评分(OR=2.455, 95%CI: 1.254~4.804, P=0.009)、SHR(OR=2.087, 95%CI: 1.053~4.137, P=0.035)、入院随机血糖(OR=1.008, 95%CI: 1.001~2.012, P=0.047)是前循环穿支动脉硬化性脑梗死后发生早期认知功能障碍的独立危险因素；相关性分析示SHR与患者发病90天MoCA评分、MMSE评分呈负相关。SHR、入院随机血糖对预测前循环穿支动脉硬化性脑梗死发生早期认知功能障碍的ROC曲线下面积分别为0.795、0.626，且2组ROC曲线下面积差异有统计学意义。结论 SHR是前循环穿支动脉硬化性脑梗死早期认知功能障碍的独立危险因素，SHR可作为预测一种认知预后的重要参考指标。
- 前循环穿支动脉粥样硬化性脑梗死 /
- 应激性高血糖比率 /
- 随机血糖 /
- 认知功能障碍
Abstract: Objective To discuss the effects of high blood sugar stress ratio on early cognitive dysfunction of patients with Anterior circulation perforator arteriosclerotic cerebral infarction. Methods From December 2014 to December 2019, patients with anterior circulation perforator arteriosclerotic cerebral infarction who were hospitalised in neurology department of Affiliated Hospital of North China University of Science and Technology were selected as the observation objects. According to the 90-day Montreal Cognitive Assessment (MoCA) score, all the patients were divided into two groups: cognitive dysfunction group(145 cases) and normal cognitive function group(187 cases). Data were collected to analyse the correlation between stress hyperglycaemia rate (SHR) and 90 day MoCA and A Mini-Mental State Examination (MMSE) scores. Receiver Operator Characteristic (ROC) curve was used to evaluate the effectiveness of SHR-related indicators in predicting cognitive impairment. Results In this study, the incidence of early cognitive impairment was 43.67%. The single-factor analysis showed that the differences in age, hypertension, diabetes history, education level, The NIH Stroke Scale (NIHSS) score, random blood sugar and SHR in the two groups were statistically significant. The Multivariate logistic regression analysis showed that age (OR=1.144, 95%CI: 1.097-1.193, P < 0.001), NIHSS score (OR=2.455, 95%CI: 1.254-4.804, P=0.009), SHR (OR=2.087, 95%CI: 1.053-4.137, P=0.035)and random blood glucose (OR=1.008, 95%CI: 1.001-2.012, P=0.047)were independent risk factors for early cognitive impairment after anterior circulation perforator arteriosclerotic cerebral infarction. Correlation analysis showed a negative correlation between SHR and MoCA and MMSE scores for 90 days. The area under ROC curve of SHR and admission random blood glucose in predicting the early cognitive impairment of patients with anterior circulation perforator arteriosclerotic cerebral infarction was 0.795 and 0.626, respectively, and the difference in area under the two sets of ROC curves was statistically significant. Conclusion SHR is an independent risk factor of cognitive dysfunction in the early stage of patients with anterior circulation perforator arteriosclerotic cerebral infarction. SHR can be used as an important reference index to predict cognitive prognosis.
- Anterior circulation perforator atherosclerotic cerebral infarction /
- Stress hyperglycaemia ratio /
- Random blood glucose /
- Cognitive impairment

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图 1 应激性高血糖比率、入院随机血糖对前循环穿支动脉硬化性脑梗死早期认知功能障碍预测的ROC曲线图

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表 1 2组前循环穿支动脉粥样硬化性脑梗死患者基线资料比较 [例(%)]

组别	例数	年龄 (x±s，岁)	性别 (男/女，例)	高血压病史	心脏病史	糖尿病史	吸烟史	饮酒史	文化程度 (高中及以上)	入院NIHSS评分 (x±s，分)
认知功能障碍组	145	69.12±6.28	86/59	105(72.4)	31(21.4)	55(37.9)	41(28.3)	50(34.5)	21(14.5)	11.33±3.58
认知功能正常组	187	62.56±5.52	115/72	112(59.9)	37(19.8)	24(12.8)	59(31.6)	55(29.4)	52(27.8)	7.12±2.46
统计量		10.110^a	0.164^b	5.655^b	0.127^b	28.369^b	0.128^b	0.971^b	8.454^b	12.680^a
P值		＜0.001	0.734	0.020	0.784	< 0.001	0.721	0.343	0.005	＜0.001
注：^a为t值，^b为χ²值。

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表 2 2组前循环穿支动脉粥样硬化性脑梗死患者临床指标比较 (x ±s)

组别	例数	入院随机血糖 (mmol/L)	HbA1c (%)	SHR	HGB(g/L)	CHO (mmol/L)	TG (mmol/L)	LDL-C (mmol/L)	HDL-C (mmol/L)	Hcy (μmol/L)
认知功能障碍组	145	8.12±1.67	6.02±0.93	1.22±0.21	138.87±22.01	5.11±1.25	2.97±0.98	4.23±1.25	1.27±0.56	17.58±6.25
认知功能正常组	187	7.35±1.87	5.86±0.82	1.09±0.08	142.07±16.21	4.89±2.04	3.12±0.94	3.98±1.28	1.19±0.61	18.23±5.86
t值		3.888	0.049	7.772	1.525	1.143	1.416	1.795	1.228	0.974
P值		< 0.001	0.097	< 0.001	0.128	0.254	0.158	0.073	0.220	0.331

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表 3 2组前循环穿支动脉粥样硬化性脑梗死患者不同时间点MoCA、MMSE评分比较 (x ±s，分)

组别	例数	MoCA		t值	P值	MMSE		t值	P值
组别	例数	入院时	90 d	t值	P值	入院时	90 d	t值	P值
认知功能障碍组	145	23.12±3.68	25.78±3.62	6.205	< 0.001	24.88±3.89	26.21±3.25	3.159	0.002
认知功能正常组	187	23.89±3.77	29.68±5.12	12.453	< 0.001	25.01±3.21	27.34±2.15	8.247	< 0.001
t值		1.865	7.786			0.333	3.802
P值		0.063	< 0.001			0.739	< 0.001

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表 4 变量赋值表

变量类别	变量名	变量赋值
因变量	认知障碍	1=是, 0=否
自变量	年龄	连续性变量
	高血压病史	1=有，0=无
	糖尿病史	1=有，0=无
	文化程度(高中及以上)	1=高中及以上，0=高中以下
	入院NIHSS评分	实测值
	入院随机血糖	实测值
	应激性高血糖比率	实测值

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表 5 认知损害发生的多因素logistic回归分析

项目	回归系数	标准误	Wald χ²	P值	OR(95% CI)
年龄	0.134	0.068	3.883	< 0.001	1.144(1.097~1.193)
文化程度(高中及以上)	-0.093	0.036	6.674	0.866	0.911(0.310~2.682)
高血压病史	0.898	0.236	14.479	0.083	1.011(0.985~2.760)
糖尿病史	0.845	0.341	6.141	0.101	1.184(0.844~3.216)
入院NIHSS评分	0.898	0.325	7.635	0.009	2.455(1.254~4.804)
SHR	0.736	0.298	6.100	0.035	2.087(1.053~4.137)
入院随机血糖	0.557	0.198	7.914	0.047	1.008(1.001~2.012)

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表 6 应激性高血糖比率与患者90天MoCA评分、MMSE评分的相关性分析

项目	r值	P值
MoCA评分	-0.681	< 0.001
MMSE评分	-0.598	< 0.001

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表 7 应激性高血糖比率、入院随机血糖对前循环穿支动脉硬化性脑梗死早期认知功能障碍预测的ROC曲线下面积比较

项目	AUC(95% CI)	SE	Z值	P值
SHR	0.795(0.747~0.836)	0.034	4.217	< 0.001
入院随机血糖	0.626(0.573~0.677)	0.024

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