Neurology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
Stroke. 2010 Oct;41(10):2366-70. doi: 10.1161/STROKEAHA.110.592170. Epub 2010 Aug 19.
Hyperglycemia after stroke is associated with larger infarct volume and poorer functional outcome. In an animal stroke model, the association between serum glucose and infarct volume is described by a U-shaped curve with a nadir ≈7 mmol/L. However, a similar curve in human studies was never reported. The objective of the present study is to investigate the association between serum glucose levels and functional outcome in patients with acute ischemic stroke.
We analyzed 1446 consecutive patients with acute ischemic stroke. Serum glucose was measured on admission at the emergency department together with multiple other metabolic, clinical, and radiological parameters. National Institutes of Health Stroke Scale (NIHSS) score was recorded at 24 hours, and Rankin score was recorded at 3 and 12 months. The association between serum glucose and favorable outcome (Rankin score ≤2) was explored in univariate and multivariate analysis. The model was further analyzed in a robust regression model based on fractional polynomial (-2-2) functions.
Serum glucose is independently correlated with functional outcome at 12 months (OR, 1.15; P=0.01). Other predictors of outcome include admission NIHSS score (OR, 1.18; P<0001), age (OR, 1.06; P<0.001), prestroke Rankin score (OR, 20.8; P=0.004), and leukoaraiosis (OR, 2.21; P=0.016). Using these factors in multiple logistic regression analysis, the area under the receiver-operator characteristic curve is 0.869. The association between serum glucose and Rankin score at 12 months is described by a J-shaped curve with a nadir of 5 mmol/L. Glucose values between 3.7 and 7.3 mmol/L are associated with favorable outcome. A similar curve was generated for the association of glucose and 24-hour NIHSS score, for which glucose values between 4.0 and 7.2 mmol/L are associated with a NIHSS score <7. Discussion-Both hypoglycemia and hyperglycemia are dangerous in acute ischemic stroke as shown by a J-shaped association between serum glucose and 24-hour and 12-month outcome. Initial serum glucose values between 3.7 and 7.3 mmol/L are associated with favorable outcome.
卒中后高血糖与更大的梗死体积和更差的功能结局相关。在动物卒中模型中，血清葡萄糖与梗死体积之间的关联呈 U 形曲线，最低点约为 7mmol/L。然而，人类研究中从未报道过类似的曲线。本研究旨在探讨急性缺血性卒中患者血清葡萄糖水平与功能结局之间的关系。
我们分析了 1446 例连续的急性缺血性卒中患者。在急诊科入院时同时测量血清葡萄糖以及其他多种代谢、临床和影像学参数。24 小时时记录国立卫生研究院卒中量表（NIHSS）评分，3 个月和 12 个月时记录 Rankin 评分。在单变量和多变量分析中探讨了血清葡萄糖与良好结局（Rankin 评分≤2）之间的关系。该模型进一步在基于分数多项式（-2-2）函数的稳健回归模型中进行了分析。
血清葡萄糖与 12 个月时的功能结局独立相关（OR，1.15；P=0.01）。结局的其他预测因素包括入院 NIHSS 评分（OR，1.18；P<0001）、年龄（OR，1.06；P<0.001）、卒中前 Rankin 评分（OR，20.8；P=0.004）和脑白质疏松症（OR，2.21；P=0.016）。在多变量逻辑回归分析中使用这些因素，接收者操作特征曲线下的面积为 0.869。血清葡萄糖与 12 个月时 Rankin 评分之间的关系呈 J 形曲线，最低点为 5mmol/L。血糖值在 3.7 至 7.3mmol/L 之间与良好结局相关。对于血糖与 24 小时 NIHSS 评分之间的关系也生成了类似的曲线，血糖值在 4.0 至 7.2mmol/L 之间与 NIHSS 评分<7 相关。讨论-如血清葡萄糖与 24 小时和 12 个月时的结局之间呈 J 形关联所示，急性缺血性卒中时低血糖和高血糖都很危险。初始血清葡萄糖值在 3.7 至 7.3mmol/L 之间与良好结局相关。
