Stroke Center, Department of Neurology, University Hospital La Paz, Madrid Autónoma University, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain.
Stroke. 2010 Oct;41(10):2362-5. doi: 10.1161/STROKEAHA.110.591529. Epub 2010 Aug 19.
We aimed to analyze the frequency of persistent hyperglycemia (PH), its implications for outcome, and to document the inpatient management of hyperglycemia.
Post hoc analysis of the GLIAS (Glycemia in Acute Stroke) study, a multicenter, prospective, and observational cohort study of 476 acute ischemic stroke patients. Capillary finger-prick glucose was determined on admission and during the first 48 hours. We defined PH was defined as at least 2 values ≥155 mg/dL. Outcome (modified Rankin Scale) was evaluated at 3 months.
PH developed in 117 patients (24.7%). PH was associated with poorer outcome (modified Rankin Scale score >2: 56.2% vs 28.1%; P<0.01) and higher mortality (26.7% vs 5.9%; P<0.01) than those with glycemia <155 mg/dL. PH ≥155 mg/dL was associated with a 4-fold increase in the odds of poor outcome at 3 months (odds ratio, 4.7; 95% confidence interval, 2.2-10.2) after adjustment for age, gender, hypertension, diabetes, stroke severity, admission glycemia, and infarct volume. Only 20% of patients with hyperglycemia ≥155 mg/dL received insulin on admission, with a progressive increase in the use of insulin during the following 48 hours. However, 114 (39.1%) out of 291 patients who received corrective treatment for hyperglycemia still had levels ≥155 mg/dL.
PH ≥155 mg/dL is a common observation in acute ischemic stroke patients that is associated with poorer outcome and higher mortality. Almost 40% of patients maintained levels ≥155 mg/dL despite corrective treatment.
我们旨在分析持续性高血糖（PH）的频率、对预后的影响，并记录高血糖的住院管理。
对多中心、前瞻性、观察性队列研究 GLIAS（急性脑卒中血糖）研究进行事后分析，该研究纳入了 476 例急性缺血性脑卒中患者。入院时和前 48 小时内通过毛细血管指尖采血测定血糖。我们将至少 2 次血糖值≥155mg/dL 定义为 PH。采用改良 Rankin 量表（mRS）评估 3 个月时的预后。
117 例（24.7%）患者发生 PH。与血糖值<155mg/dL 的患者相比，PH 患者预后更差（mRS 评分>2：56.2% vs 28.1%；P<0.01），死亡率更高（26.7% vs 5.9%；P<0.01）。血糖值≥155mg/dL 与 3 个月时预后不良的风险增加 4 倍相关（优势比，4.7；95%置信区间，2.2-10.2），校正年龄、性别、高血压、糖尿病、卒中严重程度、入院血糖和梗死体积后。入院时血糖值≥155mg/dL 的仅有 20%患者接受胰岛素治疗，在接下来的 48 小时内胰岛素的使用逐渐增加。然而，291 例接受高血糖纠正治疗的患者中仍有 114 例（39.1%）血糖值仍≥155mg/dL。
血糖值≥155mg/dL 在急性缺血性脑卒中患者中较为常见，与预后不良和死亡率升高相关。尽管进行了纠正治疗，仍有近 40%的患者血糖值维持在≥155mg/dL。
