糖尿病合併脳卒中の臨床的特徴と予後―Japanese Standard Stroke Registry Study（JSSRS）の結果より

Clinical Characteristics and Prognosis in Stroke Patients with Diabetes Mellitus：Retrospective Evaluation Using the Japanese Standard Stroke Registry Database

目的：糖尿病（DM）を基礎に持つ脳卒中の臨床的特徴や予後について，日本脳卒中協会のJSSRSによる脳卒中データバンクのデータを用いて解析した。

　方法：発症後1週間以内に入院した急性期脳卒中患者16,630例を検討。DMと高血圧（HT）の合併と脳卒中のタイプ，modified Rankin Scale（m-RS）を用いた機能予後，再発率などについて検討した。

　結果： HT（－）DM（－）群では，くも膜下出血（SAH）の頻度が比較的高く，HT（＋）DM（－）群では，脳出血が多かった。またHT（－）DM（＋）群では，ラクナ梗塞とアテローム血栓性梗塞が多く，脳出血，SAHは少なかった。HT（＋）DM（＋）群では，ラクナ梗塞とアテローム血栓性梗塞に加えて脳出血も多いのが特徴であった。予後良好群（m-RS 0～1）の頻度は，ラクナ梗塞，心原性脳塞栓，SAHにおいて，DM合併群で有意に少なかった。また，DM合併群は，有意に脳卒中の再発例が多く，機能予後におけるNIHSSやJSSの改善度に関してもインスリン治療群，DM不規則治療群で有意に不良であった。

　結語：DMはラクナ梗塞とアテローム血栓性梗塞の危険因子であり，また，DM管理不良は機能予後不良に関連することが示唆された。

We studied clinical characteristics and prognosis in acute stoke patients with diabetes mellitus registered on the Japanese Standard Stroke Registry database.A total of 16,630 acute stroke patients admitted to 56 hospitals in Japan.They were examined as to their stroke types, risk factors, their severity of stroke according to the NIH Stroke Scale (NIHSS) and Japan Stroke Scale (JSS), and outcomes by the modified Rankin Scale (m-RS).

　The incidence of subarachnoid hemorrhage was relatively high in the group of patients who had neither hypertension nor diabetes, and the incidence of brain hemorrhage was higher in the group of patients who had hypertension without diabetes.The frequencies of lacunar infarct and atherothrombotic infarct were also higher in the group of patients who had both hypertension and diabetes.In the diabetic group without hypertension, there were less numbers of hemorrhagic stroke.

　The ratio of good prognosis (m-RS 0-1) was significantly smaller in the diabetic patients with lacunar infarction, cardioembolic infarction, and subarachnoid hemorrhage.Additionally, there was significantly more stroke recurrence in the diabetic patients (33.0％ vs.26.9％, p＜0.0001).The diabetic patients who received insulin therapy (－0.8±7.4), diet therapy (－0.4±9.4), or oral medicine (－0.9±7.2), showed significantly less improvements in the NIHSS compared to the non-diabetic patients (－1.6±8.2), respectively.Moreover, the poor-management diabetic patients showed significantly less improvements in the JSS compared to non diabetic patients (3.8±7.7 vs.4.8±8.6, p＜0.005).

　In conclusions, stroke patients with diabetes mellitus showed more stroke recurrence and resulted in poorer functional recovery compared to patients without diabetes.