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目的探讨二甲双胍对合并葡萄糖耐量异常(abnormality of glucose tolerance,AGT)的缺血性卒中患者预后的影响。方法从我院初诊的596例缺血性卒中中筛查出合并AGT者155例,随机分为干预组(77例)和对照组(78例),同时从其余糖耐量正常(normal glucose tolerance,NGT)者中随机选出80例作为NGT组。3组均予相同基础治疗(阿司匹林肠溶片,100 mg/d),干预组同时予二甲双胍(500 mg,2/d)治疗,随访观察2年,比较各组治疗前后颈动脉内膜-中层厚度(IMT)的变化、再发卒中及不良反应情况。结果颈动脉IMT:干预组、对照组、NGT组治疗前分别为(1.08±0.42)mm、(1.06±0.38)mm、(0.83±0.32)mm,治疗2年后分别为(1.17±0.36)mm、(1.32±0.45)mm、(1.02±0.28)mm。干预组颈动脉IMT较治疗前无明显变化,差异无统计学意义(P>0.05),对照组与NGT组颈动脉IMT均显著增厚,差异有统计学意义(P<0.05),3组两两比较差异均有统计学意义(P<0.05);卒中再发率:干预组、对照组、NGT组分别为12.16%、25.00%、10.26%,干预组与对照组比较差异有统计学意义(P<0.05),与NGT组比较差异无统计学意义(P>0.05),对照组与NGT组比较差异有统计学意义(P<0.05);不良反应发生率:干预组、对照组、NGT组分别为3.90%、2.56%、2.50%,3组两两比较差异均无统计学意义(P>0.05)。结论二甲双胍可延缓颈动脉IMT增厚并降低合并AGT的缺血性卒中患者卒中再发的风险。
Objective To investigate the effect of metformin on the prognosis of ischemic stroke patients with abnormality of glucose tolerance (AGT). Methods A total of 155 patients with AGT were screened from 596 ischemic stroke patients newly diagnosed in our hospital and randomly divided into intervention group (n = 77) and control group (n = 78). At the same time, from the normal glucose tolerance NGT) were randomly selected 80 cases as NGT group. All the patients in the three groups were given the same basic treatment (aspirin enteric-coated tablets, 100 mg / d). The intervention group was treated with metformin (500 mg, 2 / d) for 2 years. The carotid intima- Thickness (IMT) changes, recurrent stroke and adverse reactions. Results The carotid IMT was (1.08 ± 0.42) mm, (1.06 ± 0.38) mm and (0.83 ± 0.32) mm respectively in the intervention group, the control group and the NGT group before treatment (1.17 ± 0.36) mm , (1.32 ± 0.45) mm, (1.02 ± 0.28) mm. There was no significant difference in carotid IMT between the intervention group and the control group (P> 0.05), while the IMT of the carotid artery in the control group and NGT group was significantly thicker, with significant difference (P <0.05) (P <0.05). The incidence of recurrent stroke was 12.16%, 25.00% and 10.26% respectively in the intervention group, control group and NGT group, with significant difference between the intervention group and the control group (P <0.05). There was no significant difference between the control group and the NGT group (P <0.05). There was no significant difference between the NGT group and the control group (P <0.05). The incidence of adverse reactions in the intervention group, control group, NGT group Respectively, 3.90%, 2.56% and 2.50% respectively. There was no significant difference between the three groups (P> 0.05). Conclusion Metformin delays the thickening of carotid IMT and reduces the risk of recurrent stroke in patients with ischemic stroke complicated by AGT.