糖尿病患長期血糖控制與初次腦梗塞嚴重度之相關性研究

The Relationship Between the Severity of First-ever Stroke and the Long-term Control of Blood Sugar Level in Diabetic Patients

目的：腦中風為常見的糖尿病大血管併發症之一，其中以腦梗塞為主要，可能造成死亡、嚴重功能喪失及隨之而來的巨額經濟損失，但國內外針對長期血糖控制與腦梗塞嚴重度的探討相對缺乏。方法：分析台灣南部某醫學中心於2009年1月1日至2010年12月31日期間腦中風中心資料庫中所有初次腦梗塞之糖尿病患者。腦中風資料庫提供資料包括病歷號、年齡、性別，過去病史、NIHSS、巴氏量表、改良式Rankin中風（mRS）等級，及腦中風住院一週內糖化血色素數值資料等。結果：本研究共收錄670位初次腦梗塞糖尿病患者，排除61位無糖化血色素資料患者及62位NIHSS資料不全的患者後，共有547位。比較四組糖化血色素患者的入院及出院時NIHSS、發生腦梗塞一個月後、發生腦梗塞三個月後的mRS分級時，發現糖化血色素越高，初次腦梗塞中風嚴重度越低，在入出院時NIHSS、巴氏量表分級、入院時及發生腦梗塞三個月後的mRS分級這些項目其間的差異都具統計學上的顯著意義（p＜0.05），並經Chi-square for trend test確認此一趨勢。結論：本研究發現初次腦梗塞患者糖化血色素越高，腦梗塞中風嚴重度越低，在 NIHSS、巴氏量表分級、mRS等中風嚴重度評估工具上有一致性的結果。

Purpose: Stroke is one of the major macro-vascular complications of diabetes mellitus. It is a life-threatening condition or may lead to serious long-term functional impairment and a huge economic burden on survivors. The aim of this study was to determine the relationship between the severity of a first stroke and the long-term control of blood sugar. Methods: We retrospectively collected data about diabetic patient with a first stroke admitted to the stroke center of a medical center in southern Taiwan from Jan. 1 2009 to Dec. 31 2010. Data included age, gender, past history, and National Institute of Health Stroke Scale (NIHSS), Barthel index, and modified Rankin Scale (mRS) scores. Glycated hemoglobin (HbA1) levels were determined one week after the event. Results: Data from a total of 670 diabetic patients with a first ischemic stroke were collected during this period. We excluded 123 patients whose data were insufficient. Lower HbA1c levels were associated with more serious strokes. The trend was the same for NIHSS scores on admission and discharge, and Barthel index and modified Rankin Scale (mRS) scores on discharge and three months after the stroke event. Conclusions: This study revealed that a lower HbA1c level was associated with more serious strokes. Dietary control, exercise and behavior therapy are important when helping diabetic patient learn to control their blood sugar.