Ntaios G, Papavasileiou V, Bargiota A, Makaritsis K, Michel P
Department of Medicine and Research Lab, Medical School, University of Thessaly, Larissa, Greece.
Int J Stroke. 2014 Jun;9(4):489-93. doi: 10.1111/ijs.12225. Epub 2013 Dec 29.
Poststroke hyperglycemia has been associated with unfavorable outcome. Several trials investigated the use of intravenous insulin to control hyperglycemia in acute stroke. This meta-analysis summarizes all available evidence from randomized controlled trials in order to assess its efficacy and safety.
We searched PubMed until 15/02/2013 for randomized clinical trials using the following search items: 'intravenous insulin' or 'hyperglycemia', and 'stroke'. Eligible studies had to be randomized controlled trials of intravenous insulin in hyperglycemic patients with acute stroke. Analysis was performed on intention-to-treat basis using the Peto fixed-effects method. The efficacy outcomes were mortality and favorable functional outcome. The safety outcomes were mortality, any hypoglycemia (symptomatic or asymptomatic), and symptomatic hypoglycemia.
Among 462 potentially eligible articles, nine studies with 1491 patients were included in the meta-analysis. There was no statistically significant difference in mortality between patients who were treated with intravenous insulin and controls (odds ratio: 1.16, 95% confidence interval: 0.89-1.49). Similarly, the rate of favorable functional outcome was not statistically different (odds ratio: 1.01, 95% confidence interval: 0.81-1.26). The rates of any hypoglycemia (odds ratio: 8.19, 95% confidence interval: 5.60-11.98) and of symptomatic hypoglycemia (odds ratio: 6.15, 95% confidence interval: 1.88-20.15) were higher in patients treated with intravenous insulin. There was no heterogeneity across the included trials in any of the outcomes studied.
This meta-analysis of randomized controlled trials does not support the use of intravenous insulin in hyperglycemic stroke patients to improve mortality or functional outcome. The risk of hypoglycemia is increased, however.
卒中后高血糖与不良预后相关。多项试验研究了静脉注射胰岛素在急性卒中患者中控制高血糖的应用。本荟萃分析总结了随机对照试验的所有现有证据，以评估其疗效和安全性。
我们在2013年2月15日前检索了PubMed，以查找使用以下检索词的随机临床试验：“静脉注射胰岛素”或“高血糖症”以及“卒中”。符合条件的研究必须是针对急性卒中高血糖患者进行的静脉注射胰岛素随机对照试验。采用Peto固定效应方法进行意向性分析。疗效指标为死亡率和良好的功能结局。安全性指标为死亡率、任何低血糖（有症状或无症状）以及有症状低血糖。
在462篇可能符合条件的文章中，9项研究共1491例患者被纳入荟萃分析。接受静脉注射胰岛素治疗的患者与对照组在死亡率方面无统计学显著差异（优势比：1.16，95%置信区间：0.89 - 1.49）。同样，良好功能结局的发生率也无统计学差异（优势比：1.01，95%置信区间：0.81 - 1.26）。接受静脉注射胰岛素治疗的患者发生任何低血糖（优势比：8.19，95%置信区间：5.60 - 11.98）和有症状低血糖（优势比：6.15，95%置信区间：1.88 - 20.15）的发生率更高。在所研究的任何结局中，纳入的试验之间均无异质性。
这项随机对照试验的荟萃分析不支持在高血糖卒中患者中使用静脉注射胰岛素来改善死亡率或功能结局。然而，低血糖风险会增加。
