Department of Neurology, UMC Utrecht, Utrecht, The Netherlands.
Cerebrovasc Dis. 2013;35(2):163-7. doi: 10.1159/000346588. Epub 2013 Feb 21.
Hyperglycaemia (HG) occurs in 30-40% of the patients with acute ischaemic stroke and is associated with larger infarct size and poor functional outcome. It is unknown whether HG is also associated with larger perfusion deficits in the acute stage of ischaemic stroke. As perfusion computed tomography (CT) is a reliable technique to determine the infarct core and ischaemic penumbra, we aimed to determine if patients with acute ischaemic stroke and HG have larger perfusion deficits or infarct cores on admission perfusion CT than patients with normoglycaemia (NG).
We identified 80 consecutive patients (mean age 69 ± 11 years, 58% men) with acute supratentorial non-lacunar ischaemic stroke in whom CT showed a perfusion deficit within 24 h after stroke onset. The size of the total perfusion deficit area (mean transit time of >145% compared to the contralateral hemisphere) and the infarct core area (cerebral blood volume of <2.0 ml/100 g) at the level of the basal ganglia (level 1) and at the level of the corona radiata (level 2) were compared between patients with HG (admission glucose ≥7.0 mM) and patients with NG with a MANOVA. Clinical outcome [modified Rankin Scale (mRS) score] after 6 months was correlated to glucose levels at admission.
Admission HG was present in 33 of the 80 patients (41%). A perfusion deficit was present in 79 (40% HG) patients at level 1 and 75 (43% HG) at level 2. The total area with a perfusion deficit (level 1 HG 22.1 ± 11.3 and NG 23.3 ± 12.3 cm(2); level 2 HG 27.1 ± 12.3 and NG 25.4 ± 12.0 cm(2)) and the proportion of the infarct core (level 1 HG 31 ± 30% and NG 25 ± 22%; level 2 HG 33 ± 27% and NG 26 ± 23%) did not differ significantly between the groups. HG was associated with worse outcome (mRS ≥3) at 6 months (OR 2.6, 95% CI 0.72-9.1).
As compared to patients with NG, patients with HG did not have larger perfusion deficits in the acute stage of ischaemic stroke. Nevertheless, functional outcome was worse in patients with HG, which means that poor clinical outcome in stroke patients with HG could not be explained by a larger perfusion deficit in the acute stage. Therefore, our study suggests that there might be a window of opportunity for glucose-lowering therapy in the future.
高血糖症（HG）发生在 30-40%的急性缺血性脑卒中患者中，与更大的梗死灶和较差的功能预后相关。目前尚不清楚 HG 是否也与急性缺血性脑卒中的灌注缺损较大有关。由于灌注计算机断层扫描（CT）是一种可靠的技术，可以确定梗死核心和缺血半暗带，因此我们旨在确定急性缺血性脑卒中伴有 HG 的患者与血糖正常（NG）的患者相比，在入院时的灌注 CT 上是否具有更大的灌注缺损或梗死核心。
我们确定了 80 例连续的急性幕上非腔隙性缺血性脑卒中患者（平均年龄 69 ± 11 岁，58%为男性），其中 CT 显示在脑卒中发作后 24 小时内存在灌注缺损。在基底节（1 级）和放射冠（2 级）水平上，与对侧半球相比，总灌注缺损面积（平均通过时间 >145%）和梗死核心面积（脑血容量 <2.0 ml/100 g）的大小在 HG 患者（入院时血糖≥7.0 mM）和 NG 患者之间通过 MANOVA 进行比较。6 个月后的临床结局[改良 Rankin 量表（mRS）评分]与入院时的血糖水平相关。
80 例患者中有 33 例（41%）入院时存在 HG。79 例（40% HG）患者在 1 级存在灌注缺损，75 例（43% HG）患者在 2 级存在灌注缺损。总灌注缺损面积（1 级 HG 22.1 ± 11.3 和 NG 23.3 ± 12.3 cm2；2 级 HG 27.1 ± 12.3 和 NG 25.4 ± 12.0 cm2）和梗死核心比例（1 级 HG 31 ± 30%和 NG 25 ± 22%；2 级 HG 33 ± 27%和 NG 26 ± 23%）在两组之间无显著差异。HG 与 6 个月时的不良结局（mRS≥3）相关（OR 2.6，95%CI 0.72-9.1）。
与 NG 患者相比，HG 患者在急性缺血性脑卒中阶段并未出现更大的灌注缺损。然而，HG 患者的功能结局更差，这意味着 HG 患者的脑卒中预后不良不能用急性阶段更大的灌注缺损来解释。因此，我们的研究表明，未来可能存在降低血糖治疗的机会窗。
