Paciaroni Maurizio, Agnelli Giancarlo, Caso Valeria, Corea Francesco, Ageno Walter, Alberti Andrea, Lanari Alessia, Micheli Sara, Bertolani Luca, Venti Michele, Palmerini Francesco, Billeci Antonia M R, Comi Giancarlo, Previdi Paolo, Silvestrelli Giorgio
Stroke Unit, University of Perugia, Perugia, Italy.
Cerebrovasc Dis. 2009;28(2):119-23. doi: 10.1159/000223436. Epub 2009 Jun 5.
Hyperglycemia has been claimed to be associated with hemorrhagic transformation (HT) in patients with acute ischemic stroke treated with thrombolysis. The aim of this study was to assess whether the admission blood glucose level is related to HT in a prospective study in consecutive patients with acute ischemic stroke.
Consecutive patients admitted for ischemic stroke to 4 Italian hospitals were included in this prospective cohort study.
Among 1,125 consecutive patients included in the analysis, 98 (8.7%) had HT: 62 (5.5%) had hemorrhagic infarction (HI) and 36 (3.2%) parenchymal hematoma (PH). A blood glucose level >110 mg/dl was found in 42.4% of the patients, a level between 110 and 149 mg/dl in 25.2%, and a level >150 mg/dl in 17.2%. At 3 months, 7 patients were lost at follow-up, 326 patients (29.2%) were disabled (modified Rankin score > or = 3) and 129 died (11.5%). PH was associated with an increased risk of death or disability (OR 15.29, 95% CI 2.35-99.35). However, this was not the case for HT overall and HI. At logistic regression analysis, PH was predicted by high levels of admission blood glucose (OR 1.01, 95% CI 1.00-1.01 for 1 added mg/dl). The rate of PH was 2.1% in patients with <110 mg/dl, 3.6% in patients with a level between 110 and 149 mg/dl and 6.4% in patients with a level >150 mg/dl. The curve estimation regression model showed a significant linear increase in the risk of PH related to an increase in blood glucose levels (R(2) = 0.007, p = 0.007).
Hyperglycemia during acute ischemic stroke predisposes to PH, which in turn determines a non-favorable outcome at 3 months. This relationship seems to be linear.
高血糖被认为与接受溶栓治疗的急性缺血性脑卒中患者的出血性转化（HT）有关。本研究的目的是在一项针对连续性急性缺血性脑卒中患者的前瞻性研究中，评估入院时的血糖水平是否与HT相关。
本前瞻性队列研究纳入了4家意大利医院收治的连续性缺血性脑卒中患者。
在纳入分析的1125例连续性患者中，98例（8.7%）发生了HT：62例（5.5%）为出血性梗死（HI），36例（3.2%）为脑实质血肿（PH）。42.4%的患者血糖水平>110mg/dl，25.2%的患者血糖水平在110至149mg/dl之间，17.2%的患者血糖水平>150mg/dl。3个月时，7例患者失访，326例患者（29.2%）致残（改良Rankin评分≥3分），129例患者死亡（11.5%）。PH与死亡或残疾风险增加相关（比值比15.29，95%置信区间2.35 - 99.35）。然而，总体HT和HI并非如此。在逻辑回归分析中，入院血糖水平高可预测PH（每增加1mg/dl，比值比1.01，95%置信区间1.00 - 1.01）。血糖水平<110mg/dl 的患者中PH发生率为2.1%，血糖水平在110至149mg/dl之间的患者中为3.6%，血糖水平>150mg/dl的患者中为6.4%。曲线估计回归模型显示，与血糖水平升高相关的PH风险呈显著线性增加（R² = 0.007，p = 0.007）。
急性缺血性脑卒中期间的高血糖易导致PH，进而导致3个月时预后不良。这种关系似乎是线性的。
