Correlation Of Glycosylated Hemoglobin Level And Other Risk Factors In Patients With Cerebral Infarction Complicated With Diabetes And Effect Analysis Of Acupuncture Intervention

Objective:1.through the retrospective analysis of the medical records of patients with cerebral infarction,to explore the relationship between the level of glycosylated hemoglobin and the degree of neurological impairment in patients with cerebral infarction(CI)and diabetes mellitus(DM),and to study the risk factors of CI with T2DM,so as to provide reference and ideas for the prevention of cerebral infarction in patients with diabetes.2.use meta analysis software to collect,sort out and analyze the existing clinical evidence,and clarify the treatment and safety of acupuncture and moxibustion on cerebral infarction complicated with diabetes.method:1.Retrospective study528 patients with cerebral infarction complicated with type 2 diabetes hospitalized in the Acupuncture Department of the First Affiliated Hospital of Tianjin University of traditional Chinese medicine from July 1,2016 to July 1,2021 were selected.According to the glycosylated hemoglobin value measured at admission,three subgroups were divided:normal glycosylated hemoglobin group I:HbA1c<6.5%,slightly increased hemoglobin group II:6.5%≤HbA1c<9%,and severely increased hemoglobin group III:HbA1c≥9%.The following data were collected:name,gender,age,blood glucose,glycosylated hemoglobin,number of platelets,total cholesterol,triglycerides,high-density lipoprotein,low-density lipoprotein,D-dimer,homocysteine,prothrombin time,activated partial thrombin time,thrombin time,fibrinogen and NIHSS score.At the same time,T2DM patients were divided into moderate neurological deficit(NIHSS<5points)group and severe neurological deficit(NIHSS≥5points)group according to the degree of neurological deficit.The effects of glycosylated hemoglobin on the degree of neurological deficit were compared between the two groups.2.Meta analysisIn the databases of CNKI,WF,VIP,Pub Med and EMBASE,the randomized controlled literatures on acupuncture and moxibustion for the treatment of cerebral infarction complicated with diabetes were retrieved and collected,and revman5The software was used for meta-analysis to compare the intervention effects of acupuncture and moxibustion on the effective rate,fasting blood glucose,2h postprandial blood glucose and glycosylated hemoglobin in patients with cerebral infarction and diabetes.Results:1.Retrospective study(1)Comparison of general data:there was no significant difference in gender,age and drinking history among the three groups(P>0.05);There were significant differences in smoking history(x~2=27.159,P=0.000),hypertension history(x~2=6.809,P=0.033)and coronary heart disease history(x~2=6.061,P=0.048)among the three groups(2)Comparison of biochemical indexes among the three groups:there were significant differences in Glu,FB,TC,TG,HDL-C,LDL-C and HbA1c among the three groups(P<0.05).Among them,the levels of Glu,FB,TC,TG,LDL-C and HbA1c:Group III>group II>group I;HDL-C level:group I>group II>group III.There was no significant difference in PLT,Pt,APTT,TT and Hcy(P>0.05).(3)Influencing factors of HbA1c:multiple linear regression analysis suggests Glu(β=0.573)、Fb(β=0.142)、Hcy(β=0.158)、APTT(β=0.112)、TG(β=0.081)were the influencing factors of HbA1c(all P<0.05),among which GluβMaximum value.(4)Effect of glycosylated hemoglobin level on NIHSS score:three groups of CI patients with T2DM were divided into moderate neurological deficit group(group I):NIHSS score<5,severe neurological deficit group(Group II):NIHSS score≥5;Comparing the levels of HbA1c in different degrees of neurological deficit,there was no significant difference in different degrees of neurological deficit between group I and group II(P>0.05);The degree of moderate neurological deficit in group III was less than that of severe neurological deficit(9.6 vs.10.1,P<0.05).(5)Risk factors of neurological deficit degree:according to the above univariate analysis results and common risk factors of cerebral infarction,a total of 13 risk factors are obtained:gender,age,combined smoking history,combined hypertension history,combined coronary heart disease history,Glu,D-D,FB,Hcy,TC,TG,HDL-C and LDL-C.a binary logistic regression analysis with these 13 factors as independent variables and combined moderate and severe neurological deficit as dependent variables is established.There was no significant difference between age and the degree of neurological deficit(P>0.05);HbA1c(OR:1.125,95%CI:1.103-1.250)、TG(OR:0.745,95%CI:0.579-0.957)、LDL-C(OR:0.649,95%CI:0.524,0.804)。HbA1c,TG and LDL-C have an impact on the degree of neurological deficit.With the increase of the levels of HbA1c,TG and LDL-C,the risk of neurological deficit increases.2.Meta analysisA total of 21 literatures and 1910 subjects were included.After Cochrane bias risk assessment,the quality of the included literatures was mostly low.The results of meta-analysis showed that the improvement of effective rate,fasting blood glucose,2h postprandial blood glucose and glycosylated hemoglobin in the experimental group(with acupuncture intervention)were better than those in the control group(without acupuncture intervention).The specific results are as follows:In terms of clinical efficacy,there was a statistical difference in the effective rate of acupuncture group,western medicine treatment group and rehabilitation group in the treatment of cerebral infarction complicated with diabetes(P<0.00001);There was no significant difference between acupuncture group and traditional Chinese medicine group in the treatment of cerebral infarction complicated with diabetes(P>0.05)In regulating blood glucose:there were significant differences in fasting blood glucose,2h postprandial blood glucose and glycosylated hemoglobin between acupuncture group,western medicine treatment group and rehabilitation treatment group(P<0.05).Conclusion:1.age,drinking history,history of hypertension,history of coronary heart disease,HbA1c,Glu,TG,TC,HDL-C,LDL-C are the influencing factors of patients with cerebral infarction complicated with diabetes.2.Glu and FB are the influencing factors of HbA1c,among which Glu has the greatest impact on HbA1c.3.HbA1c,TG and LDL-C all affect the degree of neurological deficit.With the increase of HbA1c,TG and LDL-C levels,the risk of neurological deficit increases.4.according to the analysis of the relevant literatures currently included,the clinical efficacy of acupuncture in the treatment of cerebral infarction complicated with diabetes is better than that of Western medicine and rehabilitation therapy;The effect of acupuncture and moxibustion on reducing blood glucose and glycosylated hemoglobin is better than that of Western medicine and rehabilitation.