Capes S E, Hunt D, Malmberg K, Pathak P, Gerstein H C
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Stroke. 2001 Oct;32(10):2426-32. doi: 10.1161/hs1001.096194.
"Stress" hyperglycemia may be associated with increased mortality and poor recovery in diabetic and nondiabetic patients after stroke. A systematic review and meta-analysis of the literature relating acute poststroke glucose levels to the subsequent course were done to summarize and quantify this relationship.
A comprehensive literature search was done for cohort studies reporting mortality and/or functional recovery after stroke in relation to admission glucose level. Relative risks in hyperglycemic compared with normoglycemic patients with and without diabetes were calculated and meta-analyzed when possible.
Thirty-two studies were identified; relative risks for prespecified outcomes were reported or could be calculated in 26 studies. After stroke of either subtype (ischemic or hemorrhagic), the unadjusted relative risk of in-hospital or 30-day mortality associated with admission glucose level >6 to 8 mmol/L (108 to 144 mg/dL) was 3.07 (95% CI, 2.50 to 3.79) in nondiabetic patients and 1.30 (95% CI, 0.49 to 3.43) in diabetic patients. After ischemic stroke, admission glucose level >6.1 to 7.0 mmol/L (110 to 126 mg/dL) was associated with increased risk of in-hospital or 30-day mortality in nondiabetic patients only (relative risk=3.28; 95% CI, 2.32 to 4.64). After hemorrhagic stroke, admission hyperglycemia was not associated with higher mortality in either diabetic or nondiabetic patients. Nondiabetic stroke survivors whose admission glucose level was >6.7 to 8 mmol/L (121 to 144 mg/dL) also had a greater risk of poor functional recovery (relative risk=1.41; 95% CI, 1.16 to 1.73).
Acute hyperglycemia predicts increased risk of in-hospital mortality after ischemic stroke in nondiabetic patients and increased risk of poor functional recovery in nondiabetic stroke survivors.
“应激性”高血糖可能与糖尿病和非糖尿病患者卒中后的死亡率增加及恢复不良有关。对有关卒中后急性血糖水平与后续病程的文献进行了系统评价和荟萃分析，以总结和量化这种关系。
对报告卒中后死亡率和/或功能恢复与入院血糖水平关系的队列研究进行全面的文献检索。计算高血糖患者与血糖正常患者（无论是否患有糖尿病）的相对风险，并在可能的情况下进行荟萃分析。
共识别出32项研究；26项研究报告或能够计算预先设定结局的相对风险。在任何一种亚型（缺血性或出血性）卒中后，入院血糖水平>6至8 mmol/L（108至144 mg/dL）时，非糖尿病患者院内或30天死亡率的未调整相对风险为3.07（95%CI，2.50至3.79），糖尿病患者为1.30（95%CI，0.49至3.43）。缺血性卒中后，仅在非糖尿病患者中，入院血糖水平>6.1至7.0 mmol/L（110至126 mg/dL）与院内或30天死亡率风险增加相关（相对风险=3.28；95%CI，2.32至4.64）。出血性卒中后，入院高血糖在糖尿病或非糖尿病患者中均与较高死亡率无关。入院血糖水平>6.7至8 mmol/L（121至144 mg/dL）的非糖尿病卒中幸存者功能恢复不良的风险也更高（相对风险=1.41；95%CI，1.16至1.73）。
急性高血糖预示非糖尿病患者缺血性卒中后院内死亡风险增加，以及非糖尿病卒中幸存者功能恢复不良风险增加。
