糖尿病患者的中风：一项基于医院的研究。

Smajlovic Dzevdet, Salihovic Denisa, Ibrahimagic Omer, Sinanovic Osman, Burina Adnan

Department of Neurology, University Clinical Centre, School of Medicine, Tuzla.

Med Arh. 2006;60(6 Suppl 2):63-5.

INTRODUCTION

Diabetes mellitus is a risk factor for stroke, but it is unclear whether stroke is different in diabetic and nondiabetic individuals. The aim of the study was to compare characteristics of stroke in patients with and without diabetes mellitus.

METHODS

This study included 833 acute stroke patients (697 [84%] had ischemic stroke, and 52% were females) admitted at the Department of Neurology Tuzla, Bosnia and Herzegovina, from January 1st 2003 to December 31st 2003. Risk factors, stroke severity (Scandinavian Stroke Scale, SSS)), stroke type, etiology, lesion topography and the outcome at 1 month (mortality and handicap) were assessed in all patients.

RESULTS

Overall, diabetes mellitus was present in 194 patients (23.5%). Females were overrepresented in the diabetic group of stroke patients (66% vs 48%, p = 0.0001). Initial stroke severity and lesion topography were comparable between the two groups. The diabetic patients reported a significantly lower current smoking (21% vs 29%) and alcohol intake (4.5% vs 9%) (p < 0.05). Patients with diabetes mellitus compared with patients without diabetes had more frequently atherothrombotic stroke (62% vs 33%, p < 0.0001), but less frequently embolic stroke (10% vs 17.5%, p = 0.02) and intracerebral hemorrhage (10% vs 18.5%, p = 0.005). Mortality at 1 month was higher in patients with diabetes mellitus (38% vs 26%, p = 0.001), and diabetes increased the relative death risk by 1.53 (95% confidence interval, 1.19 to 1.96). At the other hand, handicap (Rankin Scale) in surviving patients was insignificantly higher in diabetic group (2.7 vs 2.4, p = 0.07). Older age (70 vs 66 years, p = 0.008), atherothrombotic stroke (76% vs 53%, p = 0.002), and severe strokes (SSS 20.5 vs 39, p < 0.0001) were more associated in died stroke patients with diabetes mellitus compared with surviving diabetic stroke patients.

CONCLUSION

Diabetes mellitus is present in one fourth of acute stroke patients. Stroke patients with diabetes mellitus are associated with specific patterns of stroke type, etiology and mortality but not with stroke severity and handicap.

引言

糖尿病是中风的一个危险因素，但尚不清楚糖尿病患者和非糖尿病患者的中风情况是否存在差异。本研究的目的是比较糖尿病患者和非糖尿病患者中风的特征。

方法

本研究纳入了2003年1月1日至2003年12月31日在波斯尼亚和黑塞哥维那图兹拉神经病学系住院的833例急性中风患者（697例[84%]为缺血性中风，52%为女性）。评估了所有患者的危险因素、中风严重程度（斯堪的纳维亚中风量表，SSS）、中风类型、病因、病变部位以及1个月时的结局（死亡率和残疾情况）。

结果

总体而言，194例患者（23.5%）患有糖尿病。中风患者的糖尿病组中女性比例过高（66%对48%，p = 0.0001）。两组之间初始中风严重程度和病变部位相当。糖尿病患者报告的当前吸烟率（21%对29%）和酒精摄入量（4.5%对9%）显著较低（p < 0.05）。与非糖尿病患者相比，糖尿病患者动脉粥样硬化血栓形成性中风更为常见（62%对33%，p < 0.0001），但栓塞性中风（10%对17.5%，p = 0.02）和脑出血（10%对18.5%，p = 0.005）较少见。糖尿病患者1个月时的死亡率较高（38%对26%，p = 0.001），糖尿病使相对死亡风险增加了1.53（95%置信区间，1.19至1.96）。另一方面，存活患者中糖尿病组的残疾情况（Rankin量表）略高（2.7对2.4，p = 0.07）。与存活的糖尿病中风患者相比，死亡的糖尿病中风患者中年龄较大（70岁对66岁，p = 0.008）、动脉粥样硬化血栓形成性中风（76%对53%，p = 0.002）和严重中风（SSS 20.5对39，p < 0.0001）更为常见。