缺血性脑卒中病人糖化血红蛋白与颈动脉粥样硬化斑块的相关性研究

刘阳; 胡蕾

缺血性脑卒中病人糖化血红蛋白与颈动脉粥样硬化斑块的相关性研究

刘阳,
胡蕾

Study on the correlation between glycated hemoglobin and carotid atherosclerotic plaques in patients with ischemic stroke

LIU Yang,
HU Lei

摘要

摘要:
目的： 探讨急性缺血性脑卒中（AIS）病人糖化血红蛋白（HbA1c）水平与颈动脉粥样硬化斑块的关系。
方法： 回顾性分析进行颈动脉超声检查的AIS病人258例，依据颈动脉超声检测结果分为斑块组、IMT增厚组、正常组；依据斑块回声分为钙化斑块组、不均质回声斑块组、均质低回声斑块组；根据HbA1c水平分层，比较分析不同组病人HbA1c水平与颈动脉斑块的相关性。应用logistic回归模型绘制受试者工作特征（ROC）曲线，通过曲线下面积（AUC）来评估HbA1c的预测效能。
结果： 斑块组、IMT增厚组及正常组HbA1c平均值分别为6.61%、5.49%、5.40%，差异有统计学意义（P ＜ 0.05）。随着HbA1c值的升高，斑块厚度、长度逐渐增大，差异有统计学意义（P ＜ 0.05）。Spearman相关性分析显示，斑块长度与HbA1c呈正相关（r = 0.346，P ＜ 0.01）；斑块厚度与HbA1c呈正相关（r = 0.385，P ＜ 0.01）；颈动脉狭窄程度与HbA1c呈正相关（r = 0.932，P ＜ 0.01）。logistic回归分析提示HbA1c预测颈动脉斑块的ROC AUC为0.732，当最佳截断值为6.55%时，其敏感度和特异度分别为60.7%、81.0%。
结论： HbA1c水平与颈动脉斑块呈正相关，HbA1c水平的升高会加速斑块的进展。HbA1c水平可以作为预测颈动脉粥样硬化程度的指标。

Abstract:
Objective To investigate the association between glycated hemoglobin (HbA1c) levels and carotid atherosclerotic plaques in patients with acute ischemic stroke (AIS).
Methods A retrospective analysis was conducted on 258 AIS patients who underwent carotid ultrasonography. According to ultrasound findings, patients were classified into a plaque group, an intima-media thickness (IMT) thickening group, and a normal group. According to the echoes of the plaques, they were divided into the calcified plaque group, the heterogeneous echo plaque group, and the homogeneous hypoechoic plaque group. Stratified based on HbA1c levels, the correlation between HbA1c levels and carotid artery plaques in different groups of patients was compared and analyzed. Logistic regression was used to generate receiver operating characteristic (ROC) curves, and the predictive efficacy of HbA1c was evaluated by the area under the curve (AUC).
Results The average values of HbA1c in the plaque group, IMT thickening group and normal group were 6.61%, 5.49% and 5.40% respectively, and the difference was statistically significant (P ＜ 0.05). Higher HbA1c levels were associated with increased plaque thickness and length of the plaque gradually increased, and the difference was statistically significant (P ＜ 0.05). Spearman correlation analysis showed that plaque length was positively correlated with HbA1c (r = 0.346, P ＜ 0.01); Plaque thickness was positively correlated with HbA1c (r = 0.385, P ＜ 0.01). The degree of carotid artery stenosis was positively correlated with HbA1c (r = 0.932, P ＜ 0.01). Logistic regression analysis indicated that the area under the ROC AUC of HbA1c for predicting carotid artery plaques was 0.732. When the optimal cut-off value was 6.55%, its sensitivity and specificity were 60.7% and 81.0%, respectively.
Conclusions HbA1c levels are positively correlated with carotid atherosclerotic plaque burden, and elevated HbA1c may accelerate plaque progression. The HbA1c level can be used as an indicator to predict the degree of carotid atherosclerosis.

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