溶栓后高血糖与急性缺血性脑卒中 3 个月结局。

Post-thrombolytic hyperglycemia and 3-month outcome in acute ischemic stroke.

机构信息

Molecular Neurology Research Program, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 4, Helsinki, Finland.

出版信息

Cerebrovasc Dis. 2011;31(1):83-92. doi: 10.1159/000321332. Epub 2010 Nov 16.

DOI:10.1159/000321332

PMID:21079397

Abstract

BACKGROUND

Treating hyperglycemia in acute ischemic stroke may be beneficial, but knowledge on its prognostic value and optimal target glucose levels is scarce. We investigated the dynamics of glucose levels and the association of hyperglycemia with outcomes on admission and within 48 h after thrombolysis.

METHODS

We included 851 consecutive patients with acute ischemic stroke treated with intravenous thrombolysis in the Helsinki University Central Hospital during 1998-2008. Outcome measures were unfavorable 3- month outcome (3-6 on the modified Rankin Scale), death, and symptomatic intracerebral hemorrhage (sICH) according to NINDS criteria. Hyperglycemia was defined as a blood glucose level of ≥8.0 mmol/l. Four groups were identified based on (a) admission and (b) peak glucose levels 48 h after thrombolysis: (1) persistent normoglycemia (baseline plus 48-hour normoglycemia), (2) baseline hyperglycemia (48-hour normoglycemia), (3) 48-hour hyperglycemia (baseline normoglycemia), and (4) persistent hyperglycemia (baseline plus 48-hour hyperglycemia).

RESULTS

480 (56.4%) of our patients (median age 70 years; onset-to-needle time 199 min; National Institutes of Health Stroke Scale score 9), had persistent normoglycemia, 59 (6.9%) had baseline hyperglycemia, 175 (20.6%) had 48-hour hyperglycemia, while persistent hyperglycemia appeared in 137 (16.1%) patients. Persistent and 48-hour hyperglycemia independently predicted unfavorable outcome [odds ratio (OR) = 2.33, 95% confidence interval (CI) = 1.41-3.86, and OR = 2.17, 95% CI = 1.30-3.38, respectively], death (OR = 6.63, 95% CI = 3.25-13.54, and OR = 3.13, 95% CI = 1.56-6.27, respectively), and sICH (OR = 3.02, 95% CI = 1.68-5.43, and OR = 1.89, 95% CI = 1.04-3.43, respectively), whereas baseline hyperglycemia did not.

CONCLUSIONS

Hyperglycemia (≥8.0 mmol/l) during 48 h after intravenous thrombolysis of ischemic stroke is strongly associated with unfavorable outcome, sICH, and death.

摘要

背景

治疗急性缺血性脑卒中的高血糖可能有益，但有关其预后价值和最佳血糖水平的知识还很缺乏。我们研究了血糖水平的动态变化，以及入院时和溶栓后 48 小时内高血糖与结局之间的关系。

方法

我们纳入了 1998-2008 年在赫尔辛基大学中心医院接受静脉溶栓治疗的 851 例连续急性缺血性脑卒中患者。结局测量指标为 3-6 个月时改良 Rankin 量表评分（mRS）不良（mRS 评分≥3）、死亡和符合 NINDS 标准的症状性颅内出血（sICH）。高血糖定义为血糖水平≥8.0mmol/L。根据（a）入院时和（b）溶栓后 48 小时的血糖水平，我们将患者分为 4 组：（1）持续正常血糖（基础值+48 小时正常血糖），（2）基础值高血糖（48 小时正常血糖），（3）48 小时高血糖（基础值正常血糖），和（4）持续高血糖（基础值+48 小时高血糖）。

结果

我们的 851 例患者中，480 例（56.4%）患者为持续正常血糖（中位数年龄 70 岁；起病至溶栓时间 199 分钟；NIHSS 评分为 9），59 例（6.9%）为基础值高血糖，175 例（20.6%）为 48 小时高血糖，而 137 例（16.1%）患者出现持续高血糖。持续高血糖和 48 小时高血糖均可独立预测不良结局[比值比（OR）=2.33，95%置信区间（CI）=1.41-3.86，和 OR=2.17，95%CI=1.30-3.38]、死亡（OR=6.63，95%CI=3.25-13.54，和 OR=3.13，95%CI=1.56-6.27）和 sICH（OR=3.02，95%CI=1.68-5.43，和 OR=1.89，95%CI=1.04-3.43），而基础值高血糖则不然。