Department of Neurology, University of Heidelberg, Heidelberg, Germany.
Stroke. 2013 Aug;44(8):2134-8. doi: 10.1161/STROKEAHA.111.675918. Epub 2013 May 28.
Symptomatic intracerebral hemorrhage (sICH) is the most feared acute complication after intravenous thrombolysis. The aim of this study was to determine the predictive value of parameters of glycosylated hemoglobin A1 (HbA1c) on sICH.
In a retrospective single center series, 1112 consecutive patients treated with thrombolysis were studied. Baseline blood glucose was obtained at admission. HbA1c was determined within hospital stay. A second head computed tomography was obtained after 24 hours or when neurological worsening occurred. Modified Rankin Scale was used to assess outcome at 90 days.
A total of 222 patients (19.9%) had any hemorrhage; 43 of those had sICH (3.9%) per Safe Implementation of Treatments in Stroke definition and 95 (8.5%) per National Institute of Neurological Disorders and Stroke definition; 33.2% of patients had a dependent outcome (modified Rankin Scale score 3-5). In univariate analysis history of diabetes mellitus, HbA1c, blood glucose, and National Institute of Health Stroke Scale score on admission were associated with any hemorrhage and sICH. In multivariate analysis National Institute of Health Stroke Scale score, a history of diabetes mellitus, and HbA1c were predictors of sICH per National Institute of Neurological Disorders and Stroke, and only HbA1c when Safe Implementation of Treatments in Stroke criteria were used.
In our study, HbA1c turns out to be an important predictor of sICH after thrombolysis for acute stroke. These results suggest that hemorrhage after thrombolysis may be a consequence of long-term vascular injury rather than of acute hyperglycemia, and that HbA1c may be a better predictor than acute blood glucose or a history of diabetes mellitus.
症状性颅内出血（sICH）是静脉溶栓后最令人担忧的急性并发症。本研究旨在确定糖化血红蛋白 A1（HbA1c）参数对 sICH 的预测价值。
在一项回顾性单中心系列研究中，研究了 1112 例连续接受溶栓治疗的患者。入院时获得基础血糖值。在住院期间测定 HbA1c。当出现神经功能恶化或 24 小时后行第二次头部 CT 检查。采用改良 Rankin 量表（mRS）评估 90 天的预后。
共有 222 例（19.9%）患者发生任何出血；其中 43 例符合 Safe Implementation of Treatments in Stroke 定义的 sICH（3.9%）和 95 例符合 National Institute of Neurological Disorders and Stroke 定义的 sICH（8.5%）；33.2%的患者存在依赖状态（改良 Rankin 量表评分 3-5）。在单因素分析中，糖尿病病史、HbA1c、入院时血糖和 National Institute of Health Stroke Scale 评分与任何出血和 sICH 相关。多因素分析显示，National Institute of Health Stroke Scale 评分、糖尿病病史和 HbA1c 是 National Institute of Neurological Disorders and Stroke 定义的 sICH 的预测因素，而仅 HbA1c 是 Safe Implementation of Treatments in Stroke 标准的预测因素。
在我们的研究中，HbA1c 是急性卒中溶栓后 sICH 的重要预测因子。这些结果表明，溶栓后出血可能是长期血管损伤的后果，而不是急性高血糖的后果，HbA1c 可能是比急性血糖或糖尿病病史更好的预测因子。
