| [Background]Diabetes mellitus (DM) is a complex metabolic disorder characterized with chronic hyperglycemia, and the vascular complication is the main cause of disability and morbidity. Macrovascular complications in patients with diabetes mellitus refers to the aorta, coronary artery, brain basal arteries, renal artery and peripheral artery atherosclerosis.The prevalence of atherosclerosis,coronary heart disease and cerebrovascular disease in patients with diabetes are 4-5 times higher than non-diabetic patients.70 to 80 percent patients with diabetes die of macrovascular complications. There are roughly 20 million people with diabetes in China,many patients of them complicated with acute cerebral infarction, and the prognosis of them is poor, so domestic and foreign scholars paid much attention to that. The UKPDS study also specially designed formula to calculate the probability of stroke in patients with diabetes according cerebral infarction risk factors. Some researches show that the risk of stroke in patients with diabetes patients with diabetes is 1.5-3 times higher. Other studies also show that 67 percent of patients with diabetes are complicated by acute stroke, in the control group it is just 25 percent, the risk of stroke in patients with diabetes is significantly increased. The risk factors of developed ischemic stroke in diabetes patients are susceptibility genes; high pour-point state; high blood sugar; lipid-related disorders; regulation of hormone imbalances; meanwhile, there are other risk factors like high blood pressure, age, smoking, alcohol, obesity, race, lack of exercise, some inflammatory factors, certain infections, homocysteine and obstructive sleep apnea syndrome, etc. As people grow older, the risk of acute stroke increased continuously. After 55 years, the risk of stroke would increase double per 10 years.The prevalence of stroke display a marked gender difference, the ratio of male to female is 1.5 to 1. Highly significant correlations were found between glycosylated hemoglobin Alc(HbAlc) and blood glucose. The level of HbAlc represents blood glucose level of different stages of glycometabolism. It may be a useful index in predicting the occurrence, progress and prognosis of diabetes. The rate of progression of stroke can be delayed by aggressive management of blood glucose and HbAlc. Patients with diabetes and very high blood pressure is more common to ongoing cerebral blood vessel disease because of intracranial aneurysms and fibrinoid necrosis of arteries. The increase of blood viscosity would cause aggregation of erythrocytes, high blood pressure is complication and risk factor of diabetes. Prevalence and recurrence rate of cerebrovascular diseases significantly increase in those patients with type 2 diabetes complicated from hypertension. The diabetes had disorders of blood lipid metabolism, including tri-glyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol(LDL-C) and decreased high density lipoprotein cholesterol(HDL-C) are the common risk factors for ischemia encephalopathy of diabetes. In recent years, the total morbidity of hypertension, hyperlipidemia and diabetes is rising obviously. Diabetes mellitus associated with stroke is the main disease injury the mankind's healthiness. Its incidence and death rate are ascending year by year. Early interventions are of great importance to diabetes patients with acute stroke. The study would explore the related risk factors and pathogenesis of diabetes mellitus associated with stroke, meanwhile provide basis for the prevention and control programs.[purpose and significance]To investigate related risk factors of type 2 diabetes complicated from stroke, explore its pathogenesis, and provide basis for the prevention and control programs.[methods]Collected clinical data of 265 patients with type 2 diabetes in Nanhai People's Hospital from January 2008 to August 2009, who were divided into stroke group and non-stroke group, and all data were analyzed retrospectively and treated with statistics. Eliminated individuals with hypertension, brain trauma, tumor, chronic hepatic and renal dysfunction. Excluded individuals with acute complication and infection of diabetes in the past 3 months. Eliminated individuals who take medicine impact blood pressure, plasma glucose and plasma lipid. Recorded age, sex, height, weight, course of diabetes and whether or not the applicant smokes. Test subjects were routinely fasted 12 hours, checked fasting glucose, glycosylated hemoglobin(HbAlc), triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C), apolipoprotein A1(ApoA1), apolipoprotein B(ApoB), etc. The blood glucose measurement used glucose oxidase method; TG measurement used enzyme analysis; TC measurement used the method of oxidase; ApoA1,ApoB measurement used immune turbidimetric method. The data of this experiment was collected through testing, and SPSS 17.0 software was used to analyze the data. The statistical inference includes t test, Chi-square test, multivariate logistic regression analyses, P<0.05 mean statistical differences.[Results]1.General dataThere were 137 patients in stroke group, include 75 male and 62 female. The average age was 70.81.±7.8 years. There were 128 patients in non-stroke group, include 69 male and 59 female. The average age was 60.1±13.9 years.2.The concerning parameters between stroke group and non-stroke groupThe volumes of systolic pressure, diastolic pressure, fasting plasma glucose(p=0.007), triglyceride (TG) (p=0.000), total cholesterol (TC) (p=0.000), low density lipoprotein cholesterol(LDL-C) (p=0.000), apolipoprotein B(ApoB) (p=0.000) and BMI(p=0.000) were bigger in stroke group than those in non-stroke group(p=0.004), there were significant differences (P<0.01); the percentage of smoker was higher in stroke group than those in non-stroke group, there were significant differences (P<0.01); there were significantly difference between the two groups in sex ratios (p=0.891)and glycosylated hemoglobin(HbA1c) (p=0.561) (P>0.05).3.Multivariate logistic regression analyses was performed on data of 2 groupsThe volumes of SBP, APOB, the duration of diabetes course were independent risk factor of the diabetes mellitus associated with stroke, HDL-C was preventive factor, their value of OR were 43.556,32.940,0.004.[Conclusions]1. Multivariate logistic regression analyses was performed, results showed that age was independent risk factor of the diabetes mellitus to stroke.2. The duration of diabetes course was obviously longer in stroke group than those in non-stroke group. The results revealed that it was independent risk factor of the diabetes mellitus associated with stroke, it would affect the prevalence of macrovascular complications.3.Hypertension is the major risk factor for progression of atherosclerosis, The volumes of systolic pressure and diastolic pressure were obviously higher in stroke group than those in non-stroke group, The results revealed that they were not independent risk factor of the diabetes mellitus associated with stroke, it should be more monitored to reveal the clinical significance,4. apolipoprotein B(ApoB)was independent risk factor of the diabetes mellitus associated with acute stroke, on the contrary, HDL-C was preventive factor. |
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