应激性高血糖对接受静脉溶栓治疗的急性缺血性卒中患者早期神经功能恶化的影响。
Impact of Stress Hyperglycemia on Early Neurological Deterioration in Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis.
作者信息
Wang Ling, Cheng Qiantao, Hu Ting, Wang Nuo, Wei Xiu'e, Wu Tao, Bi Xiaoying
机构信息
Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Department of Neurology, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China.
出版信息
Front Neurol. 2022 May 13;13:870872. doi: 10.3389/fneur.2022.870872. eCollection 2022.
BACKGROUND AND PURPOSE
It has been widely reported that stress hyperglycemia contributes to poor prognosis in patients experiencing acute ischemic stroke (AIS). However, its predictive value for early neurological deterioration (END) after intravenous administration of recombinant tissue-type plasminogen activator (IV-rtPA) in AIS patients is still unclear. The aim of this study was to evaluate the impact of stress hyperglycemia on the risk of END after IV-rtPA.
METHODS
A total of 798 consecutive patients treated with IV-rtPA were included in this study. The stress hyperglycemia ratio (SHR) was calculated as fasting plasma glucose level at admission (mg/dl)/glycosylated hemoglobin (HbAlc) (%). END was defined as a National Institutes of Health Stroke Scale Score (NIHSS) ≥ 4 points 24 h after IV-rtPA, and poor functional outcome at discharge was defined as a modified Rankin Scale (mRS) score of 3-6 at discharge. Patients with a prior history of diabetes or HbAlc ≥ 6.5% were considered to have diabetes mellitus. Patients were grouped according to SHR values. Multivariate logistical regression was used to evaluate the risk of END for patients within specific SHR categories.
RESULTS
In total, 139 (17.4%) patients had END. After adjusting for confounders, the highest tertile group had higher risks of END and poor functional outcome at discharge than those of patients in the lowest tertile group (, 1.95; 95% , 1.21-3.15; = 0.006) (, 1.85; 95% , 1.163-2.941; = 0.009), and the predictive value of high SHR for END was also significant in patients with diabetes mellitus (, 3.05; 95% , 1.29-7.21; = 0.011). However, a significant association of high SHR and poor functional outcome was only found in patients without diabetes (, 1.85; 95% , 1.002-3.399; = 0.045).
CONCLUSION
A higher SHR predicted that patients with severe stress hyperglycemia had higher risks of END and poor functional outcome at discharge after IV-rtPA.
背景与目的
已有广泛报道称应激性高血糖会导致急性缺血性卒中（AIS）患者预后不良。然而，其对AIS患者静脉注射重组组织型纤溶酶原激活剂（IV-rtPA）后早期神经功能恶化（END）的预测价值仍不明确。本研究旨在评估应激性高血糖对IV-rtPA治疗后END风险的影响。
方法
本研究共纳入798例连续接受IV-rtPA治疗的患者。应激性高血糖比率（SHR）计算为入院时空腹血糖水平（mg/dl）/糖化血红蛋白（HbAlc）（%）。END定义为IV-rtPA治疗24小时后美国国立卫生研究院卒中量表评分（NIHSS）≥4分，出院时功能预后不良定义为出院时改良Rankin量表（mRS）评分为3 - 6分。既往有糖尿病史或HbAlc≥6.5%的患者被视为患有糖尿病。患者根据SHR值分组。采用多因素逻辑回归评估特定SHR类别患者的END风险。
结果
共有139例（17.4%）患者发生END。在调整混杂因素后，最高三分位数组患者发生END和出院时功能预后不良的风险高于最低三分位数组患者（比值比[OR]，1.95；95%置信区间[CI]，1.21 - 3.15；P = 0.006）（OR，1.85；95%CI，1.163 - 2.941；P = 0.009），且高SHR对END的预测价值在糖尿病患者中也具有显著性（OR，3.05；95%CI，1.29 - 7.21；P = 0.011）。然而，仅在无糖尿病患者中发现高SHR与功能预后不良存在显著关联（OR，1.85；95%CI，1.0"
结论
较高的SHR表明，严重应激性高血糖患者在IV-rtPA治疗后发生END和出院时功能预后不良的风险更高。
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