Guo Yi-Jing, Zhou Yi, Zhang Sheng-Yi, Wei Qiong, Huang Yan, Xia Wen-Qing, Wang Shao-Hua
Department of Neurology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, P.R. China.
Department of Endocrinology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, P.R. China.
Diab Vasc Dis Res. 2014 Sep;11(5):352-8. doi: 10.1177/1479164114530580. Epub 2014 Jun 12.
Hyperglycaemia is common among patients with critical neurological injury, even if they have no history of diabetes. The optimal target range for normalizing their blood glucose is unknown.
Retrospective data were extracted from 890 hyperglycaemic individuals (glucose > 200 mg/dL) admitted to neuroscience critical care unit (NCCU) and these patients were divided into two groups: intensive glucose control group with target glucose of < 140 mg/dL achieved and moderate control with glucose levels 140-180 mg/dL. The groups were also stratified according to the hyperglycaemia type (pre-existing diabetes or stress-related). We defined the primary endpoint as death from any cause during NCCU admission.
In NCCU, tighter control of blood glucose at ≤ 140 mg/dL was associated with increased, mortality of individuals with pre-existing diabetes compared with moderate control [29 of 310 patients (9.4%) vs 15 of 304 patients (4.9%), p = 0.034]. Patient age [adjusted odds ratio (OR) = 1.12; 95% confidence interval (CI) = 1.05-1.19; p < 0.001], level of glycated haemoglobin (adjusted OR = 1.24; 95% CI = 1.04-1.48; p = 0.017) and hypoglycaemia (adjusted OR = 10.3; 95% CI = 2.92-36.6; p < 0.001) were positively associated with higher mortality. Death rate was lower among stress-related hyperglycaemic patients with tighter glucose controlled at ≤ 140 mg/dL [6 of 140 patients (4.3%) vs 15 of 136 patients (11.0%), p = 0.035].
A differential association is evident between glucose levels and mortality in diabetes and stress-related hyperglycaemia patients. However, given the observational nature of our work, no clinical recommendations can be given and prospective studies are required to further investigate these findings.
高血糖在重症神经损伤患者中很常见，即便他们没有糖尿病史。血糖正常化的最佳目标范围尚不清楚。
从890名入住神经科学重症监护病房（NCCU）的高血糖患者（血糖>200mg/dL）中提取回顾性数据，这些患者被分为两组：血糖目标值<140mg/dL的强化血糖控制组和血糖水平为140 - 180mg/dL的适度控制组。这些组还根据高血糖类型（既往糖尿病或应激相关）进行分层。我们将主要终点定义为NCCU住院期间任何原因导致的死亡。
在NCCU中，与适度控制相比，将血糖严格控制在≤140mg/dL与既往有糖尿病的患者死亡率增加相关[310例患者中有29例（9.4%），304例患者中有15例（4.9%），p = 0.034]。患者年龄[调整后的比值比（OR）= 1.12；95%置信区间（CI）= 1.05 - 1.19；p < 0.001]、糖化血红蛋白水平（调整后的OR = 1.24；95%CI = 1.04 - 1.48；p = 0.017）和低血糖（调整后的OR = 10.3；95%CI = 2.92 - 36.6；p < 0.001）与较高的死亡率呈正相关。在应激相关高血糖患者中，血糖严格控制在≤140mg/dL时死亡率较低[140例患者中有6例（4.3%），136例患者中有15例（11.0%），p = 0.035]。
糖尿病患者和应激相关高血糖患者的血糖水平与死亡率之间存在明显的差异关联。然而，鉴于我们研究的观察性质，无法给出临床建议，需要进行前瞻性研究以进一步调查这些发现。
