Objective To investigate the influence and forecast value of stress hyperglycemia on the early vascular cognitive impairment (VCI) in stroke patients.Methods Totally 422 patients with acute non-diabetic stroke were divided into three groups according to the fasting plasma glucose level:the euglycemia group (<6.1 mmol/L),the mild stress hyperglycemia group (6.1-7.0 mmol/L),and the severe stress hyperglycemia group (≥7.0 mmol/L).Mini-mental state examination,Alzheimer's disease rating scale cognitive subscale,and clinical dementia rating scale were used to evaluate early cognition in post-stroke patients,and patients were divided into three groups accordingly:normal cognitive function group,mild VCI group,and vascular dementia group.Correlation analysis was carried out on the level of stress hyperglycemia and the degree of VCI.Results Of these 422 patients,stress hyperglycemia was identified in 62 cases (14.7%).The risk of stress hyperglycemia was higher in patients with a high degree of education [(8.39±3.85)years vs.(6.62±4.39)years,P=0.037)] or a history of cardiovascular disease (45.2% vs.18.3%,P=0.001).VCI was detected in 270 patients (64.0%).Age,sex,smoking,National Institute of Health Stroke Scale score,Hamilton Depression Rating Scale score,stress hyperglycemia,and history of cardiovascular disease were related with early VCI after non-diabetic ischemic stroke (P<0.05).Multivariate Logistic regression analysis showed that stress hyperglycemia was an independent risk factor for VCI in patients with non-diabetic ischemic stroke (OR=3.086,95% CI=1.065-8.929).The risks of cognitive impairment in the mild stress hyperglycemia group and the severe stress hyperglycemia group were higher than that of the euglycemia group,while it was also higher in the severe stress hyperglycemia group than in the mild stress hyperglycemia group (61.11% vs.75.00% vs.90.91%).Stress hyperglycemia was positively correlated with the high risk of early cognitive impairment in stroke patients (rs=0.185,P=0.007).Conclusion There is a significant correlation between stress hyperglycemia and early VCI after ischemic stroke.
目的 探究应激性高血糖对缺血性卒中患者早期血管性认知功能障碍(VCI)发生的影响及预测价值。方法将422例非糖尿病急性缺血性卒中患者依据空腹血糖水平分为未出现应激性高血糖组(<6.1 mmol/L)、应激性血糖轻度升高组(6.1~7.0 mmol/L)和应激性血糖显著升高组(≥7.0 mmol/L),以简易精神状态量表、阿尔茨海默病评定量表认知分量表、临床痴呆量表评定早期认知功能,根据认知诊断标准将患者分为认知功能正常组、血管性轻度认知功能障碍组和血管性痴呆组,对应激性血糖升高程度与认知功能障碍程度进行相关性分析。结果 共62例患者出现应激性高血糖,发生率14.7%,教育程度高[(8.39±3.85)年比(6.62±4.39)年,P=0.037)]、既往有心血管病史(45.2%比18.3%,P=0.001)的非糖尿病脑梗死患者早期发生应激性高血糖的风险增加。共筛查出VCI患者270例,发生率64.0%。年龄、性别、吸烟、美国国立卫生研究院卒中量表评分、汉密尔顿抑郁量表评分、应激性高血糖、心血管病史与非糖尿病缺血性卒中后早期发生VCI相关(P<0.05)。多因素非条件Logistic回归分析显示,应激性高血糖(OR=3.086,95%CI=1.065~8.929)是非糖尿病缺血性卒中患者早期发生VCI的独立危险因素。应激性血糖轻度升高组与显著升高组出现认知功能障碍的风险均高于血糖正常组,其中显著升高组又高于轻度升高组(61.11%比75.00%比90.91%),应激性高血糖水平与缺血性卒中后早期血管性认知功能障碍严重程度呈正相关(rs=0.185,P=0.007)。结论 应激性高血糖与缺血性卒中早期血管性认知障碍存在显著相关性。.