Kruyt N D, Nys G M S, van der Worp H B, van Zandvoort M J E, Kappelle L J, Biessels G J
Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, The Netherlands.
J Neurol Sci. 2008 Jul 15;270(1-2):141-7. doi: 10.1016/j.jns.2008.02.020. Epub 2008 Apr 2.
Post-stroke hyperglycemia (HG) is associated with poor physical recovery, in particular in patients with cortical stroke. We tested whether HG is also associated with cognitive impairment after ischemic stroke.
We recruited patients from a prospective consecutive cohort with a first-ever supratentorial infarct. Neuropsychological examination included abstract reasoning, verbal memory, visual memory, visual perception and construction, language, and executive functioning. We related HG (glucose >7.0 mmol/L) to cognition and functional outcome (modified Barthel Index) at baseline and after 6-10 months, and to neurological deficit (National Institutes of Health Stroke Scale) and infarct size at baseline. In additional analyses cortical and subcortical infarcts were considered separately.
Of 113 patients, 43 had HG (38%) and 55 had cortical infarcts (49%). Follow-up was obtained from 76 patients (68%). In the acute phase, in patients with cortical infarcts HG was associated with impaired executive function (B=-0.65; 95% confidence limits (CL): -1.3-0.00; p<0.05), larger lesion size (p<0.01), and more severe neurological deficits (p<0.01). These associations were not observed in patients with subcortical infarcts and the association between HG and cognitive functioning at follow-up was not significant in either group.
In first-ever ischemic stroke, HG was not associated with impaired cognition after 6-10 months. In the acute phase of stroke HG was associated with impaired executive function, but only in patients with cortical infarcts.
卒中后高血糖（HG）与身体恢复不佳相关，尤其是在皮质卒中患者中。我们测试了HG是否也与缺血性卒中后的认知障碍相关。
我们从一个前瞻性连续队列中招募了首次发生幕上梗死的患者。神经心理学检查包括抽象推理、言语记忆、视觉记忆、视觉感知与构建、语言及执行功能。我们将HG（血糖>7.0 mmol/L）与基线时以及6 - 10个月后的认知和功能结局（改良巴氏指数）相关联，并与基线时的神经功能缺损（美国国立卫生研究院卒中量表）和梗死灶大小相关联。在额外的分析中，分别考虑皮质梗死和皮质下梗死。
113例患者中，43例有HG（38%），55例有皮质梗死（49%）。76例患者（68%）获得了随访。在急性期，皮质梗死患者中HG与执行功能受损（B = -0.65；95%置信区间（CL）：-1.3 - 0.00；p<0.05）、更大的病灶大小（p<0.01）以及更严重的神经功能缺损（p<0.01）相关。在皮质下梗死患者中未观察到这些关联，且随访时HG与两组认知功能之间的关联均不显著。
在首次缺血性卒中中，HG与6 - 10个月后的认知障碍无关。在卒中急性期，HG与执行功能受损相关，但仅在皮质梗死患者中如此。
