Abstract
Objective:To investigate the effect of fasting plasma glucose (FPG) and glycosylated hemoglobin (HbAlc.) levels on thrombolytic therapy in patients with acute cerebral infarction and type 2 diabetes mellitus.Methods:A total of 135 patients with acute cerebral infarction were selected for this study. They were divided into study group (n=70, with acute cerebral infarction & type 2 diabetes mellitus) and control group (n=65, with acute cerebral infarction but no type 2 diabetes mellitus). All patients underwent thrombolysis treatment with Alteplase for injection. The patients were evaluated by the national institutes of health stroke scale (NIHSS) score, the modified Rankin scale (MRS) score and the Barthel index score, such indicators in patients as FPG, HbAlc, triglyceride (TG), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC) and high density lipoprotein cholesterol (HDL-C) were determined, the fast blood sugar before thrombolysis and the treatment effect after 24h thrombolysis in the observation group were observed and meanwhile the mortality rate in patients after 5 months thrombolysis was analyzed.Results:Compared with before thrombolysis, the indexes of the two groups were significantly improved after thrombolysis, and the improvements of FPG, HbAlc, TG and LDL-C in the control group were better than those in the study group (P<0.05). There was no significant difference between the two groups in the levels of TC and HDL-C after thrombolysis (P>0.05). The 24h MBG, SDBG and MAGE in the study group were higher than those in the control group (P<0.05). In the study group, when the blood glucose was less than 6.0mmol/L before thrombolysis, the lowest effective rate after 24h thrombolysis was 33.3%, and when the blood glucose was ranging from 7.0 to 9.0mmol/L, the highest effective rate after 24h thrombolysis was 73.9%, and with the gradual increase of blood glucose, the effective rate after 24h thrombolysis decreased gradually. Also the effective rate after 24h thrombolysis also decreased gradually with the increase of HbAlc value, it reached the highest value of 64.4% at HbAlc <6.0mmol/Lad the lowest value of 25% at HbAlc >7.0mmol/L. Compared with the control group, the MHSS score and MRS score were higher and the Barthel index after thrombolysis was lower in the study group with the difference being statistically significant (P<0.05). The five months mortality rate after thrombolytic therapy was 12.9% (9/70) in the study group and 10.8% (7/65) in the control group, with no significant difference between the two groups (P=0.316). The incidence of intracranial hemorrhage after thrombolytic therapy was higher in the study group than in the control group, but the difference was not statistically significant (P>0.05), however there was significant difference between the two groups in revascularization and prognosis (P<0.05).Conclusion:The level of HbAlc affected the curative efficacy, the higher the level, the poorer the efficacy and to control the blood glucose within a certain range before thrombolysis was beneficial to enhance the effect of static thrombolysis.
Highlights
Diabetes has got increasingly high incidence rate year by year and became a worldwide disease as well as a public health problem
The indexes of the 2 groups were significantly improved after thrombolysis, and the improvements of fasting plasma glucose (FPG), HbAlc, TG and low density lipoprotein cholesterol (LDL-C) in the control group were better than those in the study group (P
In the study group, when the blood glucose was less than 6.0mmol/L before thrombolysis, the lowest effective rate after 24h thrombolysis was 33.3%, and when the blood glucose was ranging from 7.0 to 9.0mmol/L, the highest effective rate after 24h thrombolysis was 73.9%, and with the gradual increase of blood glucose, the effective rate after 24h thrombolysis decreased gradually
Summary
Diabetes has got increasingly high incidence rate year by year and became a worldwide disease as well as a public health problem. Diabetes mellitus is an independent risk factor of first stroke and an important factor affecting the prognosis of cerebral infarction.[1] China is one of the countries with the highest incidence and mortality rate of ischemic stroke in the world. Acute cerebral infarction is one of the most common and serious complications of diabetes mellitus.[2] Its incidence in diabetic patients is 2.5-3.5 times higher than that in non-diabetic patients. According to statistics[3], about 20% of patients with acute cerebral infarction have diabetes. It has worse prognosis in diabetic patients than in those without diabetes history. The current guidebook to ultra-early intravenous thrombolysis for cerebral infarction strict rules on the blood glucose of patients conforming to time windows because the over high blood sugar will increase the risk of intravenous thrombolysis and affect the prognosis.[4,5] There are few studies about the effect of blood glucose fluctuation on thrombolytic therapy for cerebral infarction
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