糖化血红蛋白A1c水平升高与中风患者的脑白质疾病有关。
Elevated levels of hemoglobin A1c are associated with cerebral white matter disease in patients with stroke.
作者信息
Rozanski Michal, Richter Tobias B, Grittner Ulrike, Endres Matthias, Fiebach Jochen B, Jungehulsing Gerhard J
机构信息
From the Center for Stroke Research Berlin (M.R., T.B.R., U.G., M.E., J.B.F., G.J.J.), Department of Neurology (M.R., M.E.), ExcellenceCluster NeuroCure (M.E.), German Center for Neurodegenerative Diseases (M.E.), and German Center for Cardiovascular Research (M.E.), and Department for Biostatistics and Clinical Epidemiology (U.G.), Charité-Universitätsmedizin, Berlin; and Department of Neurology, The Jewish Hospital, Berlin (G.J.J.).
出版信息
Stroke. 2014 Apr;45(4):1007-11. doi: 10.1161/STROKEAHA.114.004740. Epub 2014 Feb 25.
BACKGROUND AND PURPOSE
This study was conducted to investigate the association of cerebral white matter disease (WMD) on MRI with vascular risk factors and laboratory findings in consecutive first acute ischemic stroke patients.
METHODS
Acute ischemic stroke patients underwent MRI ≤24 hours after stroke onset and follow-up on day 2. WMD was scored on fluid attenuated inversion recovery MRI according to the Wahlund score. Vascular risk factors and laboratory parameters were assessed during hospital stay. Univariate and multiple logistic regression analyses were performed.
RESULTS
We included 512 patients with first acute ischemic stroke (mean age, 68.5 [SD, 13.2] years; 192 women (37.5%); median National Institutes of Health Stroke Scale on admission, 3 [interquartile range, 1-6]; and median Wahlund score, 4 [interquartile range, 2-9]). WMD was present in 460 (89.8%) patients. In univariate analysis, age, arterial hypertension, reduced estimated glomerular filtration rate, hemoglobin A1c (HbA1c) levels, diabetes mellitus, and female sex were associated with the presence of WMD (P<0.05). In multiple regression analysis, age, arterial hypertension, and elevated levels of HbA1c (P<0.05) remained independently associated with the extent of WMD.
CONCLUSIONS
Among known risk factors, higher levels of HbA1c were associated with cerebral WMD in stroke patients. This may suggest that chronic disturbance of glycemia measured by HbA1c plays a role in the pathophysiology of WMD.
CLINICAL TRIAL REGISTRATION URL
http://www.clinicaltrials.gov. Unique identifier: NCT00715533.
背景与目的
本研究旨在调查连续性首次急性缺血性卒中患者的MRI脑白质病变（WMD）与血管危险因素及实验室检查结果之间的关联。
方法
急性缺血性卒中患者在卒中发作后≤24小时接受MRI检查，并在第2天进行随访。根据Wahlund评分在液体衰减反转恢复序列MRI上对WMD进行评分。住院期间评估血管危险因素和实验室参数。进行单因素和多因素逻辑回归分析。
结果
我们纳入了512例首次急性缺血性卒中患者（平均年龄68.5 [标准差，13.2]岁；192例女性（37.5%）；入院时美国国立卫生研究院卒中量表中位数为3 [四分位间距，1 - 6]；Wahlund评分中位数为4 [四分位间距，2 - 9]）。460例（89.8%）患者存在WMD。在单因素分析中，年龄、动脉高血压、估算肾小球滤过率降低、糖化血红蛋白（HbA1c）水平、糖尿病和女性性别与WMD的存在相关（P<0.05）。在多因素回归分析中，年龄、动脉高血压和HbA1c水平升高（P<0.05）仍与WMD的程度独立相关。
结论
在已知危险因素中，则HbA1c水平升高与卒中患者的脑WMD相关。这可能提示由HbA1c测量的血糖慢性紊乱在WMD的病理生理学中起作用。
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