Abstract: Objective To investigate the state of abnormal glucose regulation(AGR) in 609 inpatients with the first-ever ischemic stroke(FIS). To comprehend the importance of oral glucose tolerance test(OGTT) in the diagnosis of AGR.Methods Inpatients with FIS were enrolled consistently into our study from Aug. 2008 to Nov. 2009, who were hospitalized in Neurology Department of Beijing Tiantan Hospital. A total of 609 inpatients with FIS were included in the study. Age, sex, history of diabetes mellitus(DM), blood pressure, biochemical indicators, the score of National Institute of Health Stroke Scale(NIHSS)and Glasgow Coma Scale(GCS) were recorded. After 14±3 days of the patients' onsets, an oral glucose tolerance test(OGTT) would be performed to characterize the glucose metabolism status of the inpatients with FIS. The difference was compared in the diagnosis of AGR with the standard of fasting plasma glucose(FPG) and OGTT. A kappa test was done in the two diagnostic criteria of AGR and found the difference between them.Results Among 609 inpatients with FIS, the total numbers of inpatients with history of DM were 120 cases, but there were 143 cases of newly diagnosed of DM, 137 cases of newly diagnosed of impaired glucose regulation(IGR), so the general prevalence of AGR was 65.7%. The prevalenceof DM and IGR was 43.2% and 22.5% respectively. In total, 122 cases of IGR and 95 cases of DM were undiagnosed. If FPG was detected alone, 89.1% IGR and 66.4% newly diagnosed DM would have remained undiagnosed. Considered the criteria of OGTT about AGR as gold standard, a kappa test was done in the diagnostic criteria of FPG compared with that of OGTT, the value of kappa test was 0.226, P>0.05, it had statistically significance and indicated that the concordance of the two diagnostic standards was not good.Conclusion Most of inpatients with FIS have AGR in Beijing, but if the FPG was tested only, many inpatients who had AGR would be underdiagnosed, so it was very important to screen them by OGTT. The standard of OGTT couldn't be replaced by the criteria of FPG on the diagnosis of AGR.

Key words: Ischemic stroke; Glucose; regulation; Prevalence

摘要： 目的 了解北京地区首发缺血性卒中（first-ever ischemic stroke，FIS）住院患者的糖调节异常（abnormal glucose regulation，AGR）情况；了解口服葡萄糖耐量试验（oral glucose tolerance test，OGTT）在糖调节异常诊断中的重要意义。方法 选取2008年8月至2009年11月在北京天坛医院神经内科住院并连续入组的FIS患者为研究对象，有效病例609例。记录患者的年龄、性别、既往糖尿病（diabetes mellitus，DM）史、血压、各项生化指标及入院时美国国立卫生研究院卒中量表（National Institute of Health Stroke Scale，NIHSS）评分及格拉斯哥昏迷量表（Glasgow Coma Scale，GCS）评分等。于患者发病后（14±3）天行口服OGTT检查，了解FIS患者糖代谢异常情况，并采用Kappa一致性检验比较空腹血糖诊断糖调节异常标准与OGTT诊断标准间差异。结果 在609例FIS患者中，既往有明确糖尿病史患者120例，新诊断DM143例，新诊断糖调节受损（impaired glucose regulation，IGR）137例，AGR总患病率为65.7%，其中DM的患病率为43.2%，IGR的患病率为22.5%。如果仅检测空腹血糖（fasting plasma glucose，FPG），则漏诊122例IGR患者，漏诊率为89.1%，同时会漏诊95例新诊断DM患者，漏诊率为66.4%。在糖调节异常诊断上，以OGTT诊断标准为金标准，将空腹血糖标准与OGTT标准行Kappa检验，得出Kappa值=0.226，P＜0.05，提示两种诊断标准一致性较差。结论 北京地区住院FIS患者大多数合并AGR。但如果仅检测FPG则会漏诊很多AGR患者，故对入院FIS患者行OGTT筛查非常必要。空腹血糖标准不能替代OGTT标准。

关键词: 缺血性卒中; 葡萄糖; 调节; 患病率