Department of Neurology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
Nat Rev Neurol. 2010 Mar;6(3):145-55. doi: 10.1038/nrneurol.2009.231. Epub 2010 Feb 16.
Patients with acute ischemic stroke frequently test positive for hyperglycemia, which is associated with a poor clinical outcome. This association between poor glycemic control and an unfavorable prognosis is particularly evident in patients with persistent hyperglycemia, patients without a known history of diabetes mellitus, and patients with cortical infarction. To date, however, only one large clinical trial has specifically investigated the effect of glycemic control on stroke outcome. This trial failed to show a clinical benefit, but had several limitations. Despite a lack of clinical evidence supporting the use of glycemic control in the treatment of patients with stroke, international guidelines recommend treating this subset of critically ill patients for hyperglycemia in the hospital setting. This treatment regime is, however, particularly challenging in patients with stroke, and is associated with an increased risk of the patient developing hypoglycemia. Here we review the available evidence linking hyperglycemia to a poor clinical outcome in patients with ischemic stroke. We highlight the pathophysiological mechanisms that might underlie the deleterious effects of hyperglycemia on acute stroke prognosis and systematically review the literature concerning tight glycemic control after stroke. Finally, we provide directions on the use of insulin treatment strategies to control hyperglycemia in this patient group.
急性缺血性脑卒中患者常出现高血糖，这与不良临床预后相关。这种血糖控制不佳与预后不良的关联在持续高血糖患者、无已知糖尿病病史患者和皮质梗死患者中尤为明显。然而，迄今为止，只有一项大型临床试验专门研究了血糖控制对卒中结局的影响。该试验未能显示出临床获益，但存在一些局限性。尽管缺乏支持血糖控制治疗卒中患者的临床证据，但国际指南建议在医院环境中治疗这部分危重症患者的高血糖。然而，这种治疗方案在卒中患者中特别具有挑战性，并且与患者发生低血糖的风险增加相关。在这里，我们回顾了将高血糖与缺血性卒中患者不良临床结局联系起来的现有证据。我们强调了高血糖对急性卒中预后产生有害影响的病理生理学机制，并系统地回顾了卒中后严格血糖控制的相关文献。最后，我们就胰岛素治疗策略在该患者群体中控制高血糖的应用提供了指导。
