血糖水平对阿替普酶静脉溶栓治疗急性脑梗死患者疗效的影响

Effect of Blood Glucose Levels on Thrombolytic Effect of Intravenous Alteplase for Acute Cerebral Infarction

关键词:  2型糖尿病  血糖  血栓溶解

Key words:  type 2 diabetes mellitus  blood glucose  thrombolysis

摘要:

目的 研究血糖水平对阿替普酶(Recombinant tissue plasminogen activator，rt-PA)静脉溶栓治疗急性脑梗死患者疗效的影响。方法 选择2013年1月—2014年12月急诊符合rt-PA静脉溶栓标准的84例脑梗死患者，采用美国国立卫生研究院卒中量表(NIH stroke scale，NIHSS)评分，以rt-PA溶栓后24 h NIHSS分值减少≥4分或神经功能缺损症状完全消失视为有效，观察溶栓前随机血糖，入院7 d后空腹血糖、餐后2 h血糖和HbA1c等对溶栓疗效的影响。结果 rt-PA溶栓后24 h有效组溶栓前随机血糖、入院7 d后空腹血糖、餐后2 h血糖、HbA1c平均值都比无效组低，其中空腹血糖平均值有显著性差异(P<0.05)。溶栓疗效随HbA1c值升高而逐渐降低。糖尿病组或糖耐量异常组比血糖正常组溶栓疗效降低。溶栓前随机血糖在7~9 mmol·L^-1时疗效佳。结论 阿替普酶静脉溶栓疗效与血糖水平密切相关，HbA1c值越高，rt-PA溶栓后24 h疗效越差，溶栓前控制患者血糖在7~9 mmol·L^-1有助于提高rt-PA溶栓疗效。

Abstract:

OBJECTIVE To observe the effect of blood glucose levels on thrombolytic effect of intravenous alteplase for acute cerebral infarction. METHODS Eighty-four patients with acute cerebral infarction from January 2013 to December 2013 were collected, according to standard treatment for intravenous alteplase. All patients were marked by score of The National Institutes of Health Stroke Scale (NIHSS). Four points and above of NIHSS reduction 24 h after thrombolysis or symptoms entirely disappearing were defined as void. Random blood glucose before thrombolysis, fasting blood glucose, 2 h postprandial blood glucose and glycosylated hemoglobin (HbA1c) after 7 d of thrombolysis, were detected, evaluating their effect on thrombolysis. RESULTS Random blood glucose before thrombolysis, fasting blood glucose, 2 h postprandial blood glucose and HbA1c after 7d admission, were lower in effective group in 24 h after rt-PA thrombolysis, and the fasting glucose after 7 d admission had significant difference (P<0.05). Thrombolysis efficiency gradually decreased with HbA1c values. Thrombolysis efficiency was lower in diabetes group or abnormal glucose tolerance group than normal blood glucose group. Thrombolysis efficiency was better at 7.0-9.0 mmol·L^-1 of random blood glucose before thrombolysis. CONCLUSION Thrombolysis efficiency of alteplase was affected by blood glucose level, higher HbA1c value induced lower efficiency in 24 h after thrombolysis. Controlling random blood glucose before thrombolysis at 7.0-9.0 mmol·L^-1 could highly improve thrombolysis efficiency.