摘要
目的 探讨不同严重程度缺血性脑卒中患者糖脂代谢、肠道菌群水平及相关性.方法 回顾性选取2022年2月至2023年2月天门市第一人民医院收治的124例缺血性脑卒中患者作为研究对象,根据美国国立卫生研究院卒中量表(NIHSS)评分分为轻度组(NIHSS≤15分,n=39)与中重度组(NIHSS＞15分,n=85).比较两组临床资料,包括性别、年龄、体重指数、卒中家族史、高血压、空腹血糖、糖化血红蛋白(HbA1c)、总胆固醇、甘油三酯、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、拟杆菌(Bac303)、乳酸杆菌(Lab158)、梭菌属(His150).采用Spearman相关系数分析HbA1c、甘油三酯、肠道菌群与缺血性脑卒中严重程度的相关性.通过多因素Logistic回归分析对中重度缺血性脑卒中发生的危险因素进行分析.通过受试者操作特征(ROC)曲线分析肠道菌群、HbA1c、甘油三酯诊断缺血性脑卒中严重程度的价值.结果 中重度组的HbA1c、甘油三酯、His150水平分别为(6.81±1.51)％、(2.21±0.73)mmol/L、(8.12±1.22)Log10/g,均显著高于轻度组[(6.23±1.19)％、(1.70±0.54)mmol/L、(4.11±1.09)Log10/g],Bac303、Lab158 水平分别为(4.56±1.42)Log10/g、(4.34±1.17)Log10/g,均显著低于轻度组[(8.52±1.53)Log10/g、(8.19±1.31)Log10/g],差异均有统计学意义(P＜0.05).HbA1c、甘油三酯、His150与缺血性脑卒中严重程度呈正相关(P＜0.05),Bac303、Lab158与缺血性脑卒中严重程度呈负相关(P＜0.05).经多因素Logistic回归分析证实,HbA1c、甘油三酯、Bac303、Lab158、His150是中重度缺血性脑卒中发生的危险因素(P＜0.05).ROC曲线分析结果显示,HbA1c、甘油三酯、肠道菌群诊断缺血性脑卒中严重程度的曲线下面积分别为0.697、0.781、0.901、0.853、0.957,预测价值均较好(P＜0.05).结论 缺血性脑卒中严重程度与HbA1c、甘油三酯、His150呈正相关关系,与Bac303、Lab158呈负相关关系,以上指标在缺血性脑卒中病情预测、评估中有一定价值.
Abstract
Objective Exploring the observation and correlation of glucose and lipid metabolism and gut microbiota levels in patients with different degrees of ischemic stroke.Methods A total of 124 patients with ischemic stroke admitted to the First People's Hospital of Tianmen from February 2022 to February 2023 were retrospectively selected as the study subjects.According to the National Institutes of Health Stroke Scale(NIHSS)score,they were divided into mild group(NIHSS ≤15 points,n=39)and moderate to severe group(NIHSS＞15 points,n=85).The clinical data of the two groups were compared,including gender,age,body mass index,family history of stroke,hypertension,fasting blood glucose,glycosylated hemoglobin(HbA1c),total cholesterol,triglyceride,low-density lipoprotein(LDL),high-density lipoprotein(HDL),Bacteroides(Bac303),Lactobacillus(ab158),Clostridium(His150).The correlation between HbA1c,triglyceride,intestinal flora and the se-verity of ischemic stroke was analyzed by Spearman correlation coefficient analysis.The risk factors of moderate to severe ischemic stroke were ana-lyzed by multivariate Logistic regression analysis.The value of intestinal flora,HbA1c and triglyceride in the diagnosis of ischemic stroke severity-was analyzed by receiver operating characteristic(ROC)curve.Results The levels of HbA1c,triglyceride,and His150 in the moderate to severe group were(6.81±1.51)％,(2.21±0.73)mmol/L,and(8.12±1.22)Log10/g,respectively,which were significantly higher than those in the mild group(6.23±1.19)％,(1.70±0.54)mmol/L,and(4.11±1.09)Log10/g,the levels of Bac303 and Lab158 were(4.56±1.42)Log1o/g and(4.34±1.17)Log10/g,respectively,which were significantly lower than those in the mild group(8.52±1.53)Log10/g and(8.19±1.31)Log10/g,and the differences were statistically significant(P＜0.05).HbA1c,triglycerides and His150 were positively correlated with the severity of ischemic stroke(P＜0.05),while Bac303 and Lab158 were negatively correlated with the severity of ischemic stroke(P＜0.05).Multivari-ate Logistic regression analysis confirmed that HbA1c,triglycerides,Bac303,Lab158,and His 150 are risk factors for moderate to severe ischemic stroke(P＜0.05).The ROC curve analysis results showed that the area under the curve for diagnosing the severity of ischemic stroke based on HbA1c,triglycerides,and gut microbiota were 0.697,0.781,0.901,0.853,and 0.957,respectively,and the predictive value was good(P＜0.05).Conclusion The severity of ischemic stroke is positively correlated with HbA1c,triglycerides and His150,and negatively correlated with Bac303 and Lab1 58.The above indicators have certain value in the prediction and evaluation of ischemic stroke.
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