Vancheri F, Curcio M, Burgio A, Salvaggio S, Gruttadauria G, Lunetta M C, Dovico R, Alletto M
Unità Operativa di Medicina Interna, Ospedale S. Elia, Caltanisetta, Italy.
QJM. 2005 Dec;98(12):871-8. doi: 10.1093/qjmed/hci134. Epub 2005 Oct 20.
About a third of patients with acute stroke and no prior diagnosis of diabetes have hyperglycaemia during the acute phase of stroke. Whether this is an acute stress response or a reflection of underlying diabetes is controversial.
To assess whether impaired glucose metabolism in patients with acute ischaemic stroke and no previous diagnosis of diabetes persists after 3 months, and whether such persistence can be predicted.
Prospective observational study.
We enrolled 106 patients with acute ischaemic stroke and no history of diabetes. Fasting blood glucose, serum insulin and the insulin resistance index HOMA were recorded during hospital stay. A standard oral glucose tolerance test was performed at discharge and 3 months later.
Ten patients did not complete the study. Eighty-one patients (84.4%) had abnormal glucose metabolism at discharge and 62 (64.6%) after 3 months. Thirty-seven (38.5%) had impaired glucose tolerance at discharge and 26 (27.1%) after 3 months. Forty-four (45.8%) had diabetes at discharge, and 36 (37.5%) at 3 months. Post-load hyperglycaemia at discharge was a predictor of diabetes after 3 months. A plasma glucose cut-off of 11.7 mmol/l (210 mg/dl) had a specificity of 90.0% and a positive predictive value of 81.3%. HOMA increased progressively from patients with normal glucose metabolism to those with newly diagnosed diabetes.
Impaired glucose tolerance and previously unrecognized diabetes could be detected early in the stroke course, and persisted after 3 months in more than two-thirds of our patients. Post-load hyperglycaemia during the acute phase of stroke may be useful in identifying patients with abnormal glucose metabolism, which places them at risk for adverse outcomes, including cardiovascular disease.
约三分之一急性卒中且既往无糖尿病诊断的患者在卒中急性期会出现高血糖。这是急性应激反应还是潜在糖尿病的反映存在争议。
评估急性缺血性卒中且既往无糖尿病诊断的患者葡萄糖代谢受损在3个月后是否持续存在，以及这种持续性是否可预测。
前瞻性观察性研究。
我们纳入了106例急性缺血性卒中和无糖尿病病史的患者。住院期间记录空腹血糖、血清胰岛素和胰岛素抵抗指数HOMA。出院时及3个月后进行标准口服葡萄糖耐量试验。
10例患者未完成研究。81例患者（84.4%）出院时葡萄糖代谢异常，3个月后为62例（64.6%）。37例（38.5%）出院时糖耐量受损，3个月后为26例（27.1%）。44例（45.8%）出院时患有糖尿病，3个月时为36例（37.5%）。出院时负荷后高血糖是3个月后糖尿病的预测指标。血糖临界值为11.7 mmol/l（210 mg/dl）时，特异性为90.0%，阳性预测值为81.3%。HOMA从葡萄糖代谢正常的患者逐渐升高至新诊断糖尿病的患者。
在卒中病程早期可检测到糖耐量受损和既往未识别的糖尿病，且在我们超过三分之二的患者中3个月后仍持续存在。卒中急性期的负荷后高血糖可能有助于识别葡萄糖代谢异常的患者，这些患者有发生包括心血管疾病在内的不良结局的风险。
