目的探索急性缺血性脑卒中(acute ischemic stroke,AIS)合并糖尿病人群的血糖变异性与神经功能损害的相关性。方法选取AIS合并糖尿病患者125例,记录基线状态下一般临床资料,并分别于入院及出院时进行美国国立卫生研究院卒中量表(Nationa...目的探索急性缺血性脑卒中(acute ischemic stroke,AIS)合并糖尿病人群的血糖变异性与神经功能损害的相关性。方法选取AIS合并糖尿病患者125例,记录基线状态下一般临床资料,并分别于入院及出院时进行美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分,于出院1个月后随访进行改良Rankin量表(modified Rankin Scale,mRS)评分,评估患者卒中后神经功能变化与残障情况。根据NIHSS评分是否上升分为非恶化组(79例)和恶化组(46例),对比两组基线资料和血糖变异性参数。采用Logistic回归分析影响神经功能恶化的可能因素,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估血糖变异性指标对神经功能恶化的预测价值。结果两组基线临床资料相比差异无统计学意义,两组血糖变异性参数相比,葡萄糖目标范围内时间(time in range,TIR)、平均血糖波动幅度(mean amplitude of glycemic excursions,MAGE)、最大血糖波动幅度(largest amplitude of glycemic excursions,LAGE)差异均存在统计学意义(P<0.05)。二元Logistic回归分析显示,TIR(OR=0.937,P<0.001)、MAGE(OR=1.360,P=0.024)、LAGE(OR=1.364,P=0.015)是NIHSS评分恶化的危险因素。有序多因素Logistic回归分析提示,入院48 h血糖平均值(OR=1.208,P=0.033)、MAGE(OR=1.206,P=0.040)以及入院空腹血糖(OR=1.182,P=0.016)是影响mRS评分的危险因素。ROC曲线提示TIR预测发生恶化的曲线下面积(area under the curve,AUC)为0.781(95%CI:0.699-0.862,P<0.001),灵敏度为82.6%,特异度为60.8%,最佳截断值为41.3%。结论以TIR等为代表的血糖变异性指标可能是提示AIS合并糖尿病患者神经功能恶化的相关因素。展开更多
Hypoxia-inducible factor(HIF) is an important transcript factor in sensing the concentration of O2 in cell and regulating the adaptation to hypoxia.HIF is consist of two subunits called α and β with α as an oxygen-...Hypoxia-inducible factor(HIF) is an important transcript factor in sensing the concentration of O2 in cell and regulating the adaptation to hypoxia.HIF is consist of two subunits called α and β with α as an oxygen-sensitive unit and β as a constitutively expressed unit.The activity of HIF is regulated by both pVHL/proteasomal destruction system and non pVHL/proteasomal destruction system.Because the brain is the most oxygen-sensitive organ,use of HIF may be a potential application in treating cerebral ischemia disease.Yet HIF is reported to have both neuroprotective and proapoptotic functions in cerebral ischemia,which makes the application of HIF more complicated.This review will discuss the possible function and mechanism of HIF in cerebral ischemia,and the possible application of HIF to clinic.展开更多
文摘目的探索急性缺血性脑卒中(acute ischemic stroke,AIS)合并糖尿病人群的血糖变异性与神经功能损害的相关性。方法选取AIS合并糖尿病患者125例,记录基线状态下一般临床资料,并分别于入院及出院时进行美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分,于出院1个月后随访进行改良Rankin量表(modified Rankin Scale,mRS)评分,评估患者卒中后神经功能变化与残障情况。根据NIHSS评分是否上升分为非恶化组(79例)和恶化组(46例),对比两组基线资料和血糖变异性参数。采用Logistic回归分析影响神经功能恶化的可能因素,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估血糖变异性指标对神经功能恶化的预测价值。结果两组基线临床资料相比差异无统计学意义,两组血糖变异性参数相比,葡萄糖目标范围内时间(time in range,TIR)、平均血糖波动幅度(mean amplitude of glycemic excursions,MAGE)、最大血糖波动幅度(largest amplitude of glycemic excursions,LAGE)差异均存在统计学意义(P<0.05)。二元Logistic回归分析显示,TIR(OR=0.937,P<0.001)、MAGE(OR=1.360,P=0.024)、LAGE(OR=1.364,P=0.015)是NIHSS评分恶化的危险因素。有序多因素Logistic回归分析提示,入院48 h血糖平均值(OR=1.208,P=0.033)、MAGE(OR=1.206,P=0.040)以及入院空腹血糖(OR=1.182,P=0.016)是影响mRS评分的危险因素。ROC曲线提示TIR预测发生恶化的曲线下面积(area under the curve,AUC)为0.781(95%CI:0.699-0.862,P<0.001),灵敏度为82.6%,特异度为60.8%,最佳截断值为41.3%。结论以TIR等为代表的血糖变异性指标可能是提示AIS合并糖尿病患者神经功能恶化的相关因素。
文摘Hypoxia-inducible factor(HIF) is an important transcript factor in sensing the concentration of O2 in cell and regulating the adaptation to hypoxia.HIF is consist of two subunits called α and β with α as an oxygen-sensitive unit and β as a constitutively expressed unit.The activity of HIF is regulated by both pVHL/proteasomal destruction system and non pVHL/proteasomal destruction system.Because the brain is the most oxygen-sensitive organ,use of HIF may be a potential application in treating cerebral ischemia disease.Yet HIF is reported to have both neuroprotective and proapoptotic functions in cerebral ischemia,which makes the application of HIF more complicated.This review will discuss the possible function and mechanism of HIF in cerebral ischemia,and the possible application of HIF to clinic.
