【作者】 沈锷；

【导师】 张爱珍；

【作者基本信息】 浙江大学 ， 内科学， 2005， 硕士

【摘要】 目的 通过对糖尿病合并脑梗塞的临床特点分析,力求对该疾病做到早期诊断、早期防止。 方法 随机选择自1999年8月-2005年3月浙江大学医学院附属第二医院神经内科病房收治的糖尿病合并脑梗塞30例(糖尿病组),与同期非糖尿病脑梗塞21例(对照组)进行对照分析,并结合相关文献复习,探讨该疾病的一些特点。 结果 (1)糖尿病组30例患者男性17例,女性13例。年龄50-89岁,平均年龄73.77岁。除1例为1型糖尿病外均为2型糖尿病。(2)糖尿病组偏瘫、失语、病理征阳性较对照组显著减少(P<0.05)。(3)血生化及凝血谱测定示糖尿病组FBG、TG、Fbg、BUN均明显高于对照组(P<0.01、P<0.05、P<0.01、P<0.05)。(4)糖尿病组双侧基底节区脑梗塞、多发性、复发性脑梗塞较对照组显著增多(P<0.05)。(5)肾功能不全、肺部感染、泌尿系感染在糖尿病组有显著增多(P<0.05)。 结论 糖尿病合并脑梗塞的特点为:主要见于老年2型糖尿病患者;偏瘫等定位体征相对较少而易于漏诊;梗塞灶多位于白质深部,以基底节区多见;以中小梗塞为主,尤其多见腔隙性梗塞;双侧性、多发性梗塞所占比例大,且易复发。在血糖控制不佳者更多见,血TG、LDH-C多明显升高,HDL-C多降低,TC也可略高,Fbg可见明显升高。肺部感染等合并症较多,恢复较慢,预后相对差。宜在积极控制血糖基础上综合治疗以降低致残率、死亡率。更多还原

【Abstract】 Objective To study the clinical characteristics of diabetes complicated with cerebral infarction and increase the understanding of early diagnosis and prevention. Methods 30 cases of diabetes complicated with cerebral infarction random selected from the Neurology Department of the 2nd Affiliated Hospital of Zhejiang University Medical School were compared with 21 controls of non-diabetes cerebral infarction in the same period . Some relevant literature reviews were presented in our article. Results (1)30 cases include 17 males and 13 females, at an age range of 50-89.All cases are T2DM except one of T1DM. (2)The rate of hemiparalysis, aphasia pathologic sign(+) in case are significantly lower than in control (P<0.05). (3) FBG TG Fbg BUN in case are significantly increased (P<0.01 P<0.05, P<0.01 P<0.05) . (4) the rate of two-sides basal ganglia-, multiple , recurrence cerebral infarction in case are significantly higher than in control (P<0.05) . (5) renal inadequacy, pulmonary infection and urinary system infection in case are significant increased (P<0.05) . Conclusion the clinical characteristics of diabetes complicated with cerebral infarction: the majority occurred in the old patients of T2DM;Misdiagnosis are often occur in clinic because hemiparalysis and other physical signs of localization are relatively fewer; Infarction focus on deep substantia alba with the majority in basal ganglia; Microinfarct especially lacunar infarction, double sides, multiple and recurrence infarction can often be found. Blood FBG TG, LDH-C and Fbg significantly increased while HDL-C often decreased. With more pulmonary infection and other complications, patient with diabetes complicated with cerebral infarction recover more slowly and have a worse prognosis. Combined therapy based on positive control of blood glucose should be taken in order to lower the rate of mutilation and mortality.更多还原