| BackgroundDiabetes Mellitus (DM) is one of of the three harmful diseasesto human health which are listed by the World Health Organization. Chronic high blood sugar can induce a variety of chronic complications, the most important one is the microvascular damage.75% of people with diabetes die of diabetic vascular complications. Death rate of diabetic cerebrovascular disease ranked second overall the causes of death in diabetes, and stroke accounts for about 10%. In addition, the incidence of cerebral infarction in patients with diabetes is 2 to 4 times higher thanthe non-diabetic patients. The patients died of stroke is 2 times higher than non-diabetic patients. Therefore, diabetic cerebral infarction has both characteristics of diabetes and cerebral infarction, which is great harmful to human health. It is significant to study how to prevent and treat.The primary goal of prevention and treatment fordiabetic cerebral infarction is to control blood sugar, which is the main mean to reducethe complications of diabetic cerebral infarction. Glycated hemoglobin (Glycated Hemoglobin Ale, GHbAlc) is a product of glucose in the blood and erythrocyte hemoglobin. It is the index of the evaluation for glycemic control. The index can accurately reflect the average blood glucose levels in patients within recent 8 to 12 weeks. It cannot be affected by the temporary change of blood sugar. Thereby, it is widely used in both clinical practice and research work.This study aimed to explore the relevance between glycated hemoglobin and progression and prognosis of patients with diabetic cerebral infarction, so as to study the clinical significance of glycated hemoglobin, and to further explore the possible etiology and pathogenesis of diabetic cerebral infarction.Methods331 initial onset patients of acute cerebral infarction whois hospitalized in our hospital neurology between May 2009 to December 2012 were continuously collected.After excluding cardiogenic cerebral embolism, other reasons and unexplained cerebral infarction,269 cases of acute cerebral infarction of patients with first episode who meets the inclusion criteria were included in our study. Glycated hemoglobin levels were measured for each patient at admission. Patients were divided into two groups:patients with diabetes (93 cases) and patients without diabetes(176 cases). The diabetic patients with cerebral infarction according to the admission measured hemoglobin level were divided into three groups of patients:light group with HbAlc<6.5 (36 cases), medium group with 6.5≤HbAlc≤ 9.0 (32 patients), severe group with HbAlc> 9.0 (25 patients). At the admission and 30 days after treatment NIHSS scorewere measured, the results were analyzed. Then we analyze its overall efficiency results based on the efficacy standards of The Fourth National Stroke Conference established. According to the TOAST etiology of stroke classificationthe patients in each group then were respectively divided into two groups, one with large artery atherosclerotic and another with small artery occlusion. At last, the ratio of small artery occlusion was analysed statistically in patients with diabetes and patients without diabetes.Results:(1)The cerebral infarction patients withand without diabetichad no significant difference (P> 0.05) atage, sex ratio, blood pressure, blood sugar, blood lipids, D-Dimer, BMI, history of coronary heart disease and stroke, etc. But two groups hadsignificant difference at FBG, HbAlC (P< 0.001) and Fib(P<0.05).(2)The non-diabetic group had a better prognosis (89.21%) than diabetic cerebral infarction group (70.97%) and the difference was statistically significant (P<0.001).(3) In diabetic cerebral infarction group, mild, moderate and severe groups according to glycated hemoglobinhad significant difference in prognosis. Light group (88.89%) was superior than medium group (71.88%) (P<0.001) and severe group (44%) (P<0.001), and there were significant differences. Medium group was superior than severe group (P<0.001), and the difference was statistically significant (P<0.05).(4) Compared with cerebral infarction with non-diabetic patients (57.39%).patients with cerebral infarction small artery occlusion in diabetic group (68.82%) were more dominant relatively, and the difference was statistically significant (P<0.05).ConclusionsThis study that confirmed the glycated hemoglobin can forecastthe progression of diabetic cerebral infarction, and assess the prognosis of diabetic patients with cerebral infarction. Measuring glycated hemoglobin can help clinicians to detect whether the patients who had no diabetes history had diabetes or notin the early stages, and to prepare for early intervention. At the same time, we confirmed the hazards of diabetes on the small arteries is more severe than the aorta through further analysis. |
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