Effect Of Sulfonylureas On Acute Ischemic Stroke With Type 2 Diabetes Mellitus And Its Distribution Of Yin And Yang Syndrome

ObjectiveGlibenclamide can reduce cerebral edema and hemorrhage conversion rate in patients with cerebral infarction by inhibiting the surl-trpm4 channel.The purpose of this study is:1.To observe the correlation of sulfonylureas on short-term neurological outcome and hemorrhage transformation in patients with acute ischemic stroke and type 2 diabetes mellitus.2.To observe the distribution of Yin and Yang syndrome in patients with acute ischemic stroke and type 2 diabetes mellitus.MethodA retrospective analysis was performed on the patients with acute ischemic stroke and type 2 diabetes mellitus who were admitted to the Department of Neurology,Guangdong Provincial Hospital of Chinese Medicine from January 2015 to December 2017.Sulfonylureas(SU)were divided into SU group and non-SU group according to whether SU was used.The NIHSS score,occurrence and death of hemorrhage transformation were observed in the two groups.Statistical analysis was performed using SPSS22.0 statistical software.To observe the correlation of sulfonylureas on short-term neurological outcome and hemorrhage transformation in patients with acute ischemic stroke and type 2 diabetes mellitus.And to observe the distribution of Yin and Yang syndrome in patients with acute ischemic stroke and type 2 diabetes mellitus.Result1.225 patients with acute ischemic stroke and type 2 diabetes mellitus were enrolled(63.6%male,mean age 69 year)in our study including 115 patients in the SU group and 110 patients in the non-SU group.The average time of admission was 67.7h,the incidence rate was 48%at 24h,the NIIISS score was 5.13±4.53 at admission,the hospital stay was 13.2±5.6 days,and the proportion of patients with yin syndrome:yang syndrome was 143:82.2.The neurological functional recovery during the hospitalization of the SU group and the non-SU group(30.4%:13.5%,P<0.05)were statistically significant.3.The hemorrhage transformation rate(0.87%:6.36%,P<0.05)in the SU group and the non-SU group was statistically significant.There was no statistical difference in symptomatic(0.87%:3.63%,P>0.05)and non-symptomatic(0%:2.73%,P>0.05).4.There was no significant difference in mortality between the SU group and the non-SU group(0%:0.91%,P>0.05)(1 patient died of cerebralpalsy).5.In the univariate analysis,NIHSS score,platelet count,SU,history of atrial fibrillation,rtPA and mechanical thrombolysis were the risk factors for hemorrhage transformation in patients with acute ischemic stroke and type 2 diabetes mellitus(P<0.05).In the multivariate analysis,atrial fibrillation and rtPA were risk factors influencing the occurrence of hemorrhage conversion(P<0.05).6.In the univariate analysis,SU was the risk factors for neurological functional recovery in patients with acute ischemic stroke and type 2 diabetes mellitus(P<0.05).And SU was also the statistically significant in multivariate analysis(OR:7.932,95%CI:3.472-18.119,P=0.000).7.In the univariate analysis,platelet count,history of hypertension,and blood glucose were the risk factors affecting the distribution of yin and yang syndromes in patients with acute ischemic stroke and type 2 diabetes mellitus(P<0.05).In the multivariate analysis,Hypertension(OR:0.335,95%CI:0.132-1.932,P=0.032)was associated with the distribution of yin and yang syndromes.Conclusion1.Sulfonylureas can improve short-term neurological outcomes inpatients with acute ischemic stroke and type 2 diabetes mellitus,and reduce the rate of hemorrhagic transformation.2.Yin and Yang syndromes are mostly yin-like syndromes,and hypertension is associated with the distribution of yin-yang syndromes.