Clinical Study On The Relationship Between Acute Ischemic Stroke And Abnormal Glucose Regulation

Objective：①To investigate the prevalence of abnormal glucose metabolism a-mong patients with acute ischemic stroke(AIS).②To study the demographiccharacteristics and the clinical characteristics of AIS patients with impaired glucoseregulation.③To explore the etiology of AIS patients with abnormal glucosemetabolism.Methods：Prospective observational studied，patients were hospitalized for AISfrom Oct.2011through Oct in First Affiliated Hospital of Henan University of Scienceand Technology and were performed brain MRI(DWI). Patient baseline informationwas recorded within24hours after admission, including sex, age, height, weight, waistcircumference, hip circumference, body mass index, history of diabetes, hypertension,coronary heart disease, smoking, alcohol, and stroke, fasting glucose concentration(FPG)(mmol/l), Hemoglobin Alc(%), homocysteine, low density lipoprotein (mmol/l),cholesterol(mmol/l), triglyceride concentration(mmol/l). An oral glucose tolerancetext(OGTT) was preformed in all the patients without previous diabetes at the day7±3after stroke,onset.According to the OGTT results,AIS patients were divided into threegroups: normal glucose tolerance group (NGT), IGR (IFG+IGT)group, DM group.Theetiologic subtypes of ischemic stroke were classified according to the ChineseIschemic Stroke Subclassification(CISS).Results：1.Consecutive collection of412patients with AIS,372patients were effectivelyincluded.Of all the372patients with AIS,the prevalence of abnormal glucoseregulation and diabetes were78.2%and44.6%.The prevalence of impaired glucoseregulation(IGR)[(impaired fasting glucose,IFG) and (impaired glucosetolerance,IGT)and(complex impaired glucose tolerance, IFG+IGT)]was33.6%.The prevalence of only IGT, only IFG,IFG+IGT,and (normal glucose tolerance,NGT)were25.8%,1.6%,6.2%,and21.8%,respectively.Of the372AIS patients,94had history ofdiabetes and OGTT results were available for203patients who had no history ofdiabetes. Of all the Patients with no history of diabetes,46were newly diagnosed DMand29were newly diagnosed IGR based on FPG.As well as26were newly diagnosedDM and96were newly diagnosed IGR and81were newly diagnosed NGT based onOGTT results.2.According to oral glucose tolerance test(OGTT), The cutpoints of HbA1c fordiagnosis of IGR was5.45%(sensitivity84.8%,specificity75.0%),and6.05%fordiagnosis of diabetes (sensitivity84.8%,specificity75.0%).3.Body mass index, waist circumference, hip circumference, waist/hip ratio，homocysteine were not statistically significant among three groups (P>0.05), andhistory of smoking,alcohol, stroke and coronary heart disease was not statisticallysignificant among three groups (P>0.05).Compared with the NGT group, men(X2=6.070, P=0.009)and history ofhypertension(X2=7.004，P=0.006) were higher in the DM group. Compared with theDM group, history of smoking(X2=8.994，P=0.003),history of drinking(X2=5.594，P=0.014)were higher in the NGT group.The prevalence of hyperlipidemia of the IGRgroup was higher than that of the NGT group (P<0.05), and DM group higher than thatof the IGR group (P<0.05) and the NGT group (P<0.05). Hemoglobin Alc of the IGRgroup was higher than that of the NGT group (P<0.01), and DM group higher than thatof the IGR group(P<0.01)and the NGT group (P＜0.01).4.The prevalence of AGR among the patients with aged≧60years was higherthan those aged <60years (X2=6.615,P=0.037<0.05).5.Of all the patients, The majority of patients were identified as having largearteries atherosclerosis (LAA)(208cases), followed by penetrating artery disease(PAD)(45cases), undetermined etiology (UE)(n=5), cardiogenic stroke (CS)(26cases),other etiology(UE)(5cases)).In125IGR patients, the most frequent subtypewas large arteries atherosclerosis（90cases）, followed by penetrating artery disease(PAD)(18cases)，cardiogenic stroke(CS)(13cases), undetermined etiology(UE)(1cases), other etiology (UE)(3cases).In166DM patients，the most frequent subtype was large arteries atherosclerosis(118cases), followed by penetrating artery disease(PAD)(14cases), cardiogenic stroke (CS)(27cases), undetermined etiology(UE)(4cases), other etiology(UE)(3cases).Group DM compared with group IGR,theclassification of stroke was no significance(X2=1.663,p=0.797＞0.05).Conclusion:1.The prevalence of abnormal glucose metabolism in patients with AIS ishigh.More patients with abnormal glucose metabolism may be identified by OGTTthan those by FPG only among the patients with AIS.2.OGTT is suggested to be performed among AIS patients with those aged≥60years or with hyperlipidemia or with HbA1c≥5.45%to identify a large percentage ofpatients with IGR.3.Large artery atheroselerosis is the most frequent subtype among AIS patientswith abnormal glucose tolerance.