Fuentes Blanca, Cruz-Herranz Andrés, Martínez-Sánchez Patricia, Rodríguez-Sanz Ana, Ruiz Ares Gerardo, Prefasi Daniel, Sanz-Cuesta Borja E, Lara-Lara Manuel, Díez-Tejedor Exuperio
Department of Neurology and Stroke Center, IdiPAZ Health Research Institute, La Paz University Hospital, Autonomous University of Madrid, Paseo de la Castellana 261, 28046, Madrid, Spain,
J Thromb Thrombolysis. 2014 Nov;38(4):522-7. doi: 10.1007/s11239-014-1110-5.
The benefit of intravenous thrombolysis (IVT) has been questioned for patients with diabetes mellitus (DM) in cases of acute ischemic stroke (IS). Our objective was to analyze the differences in outcome according to prior diagnosis of DM and the use or not of IVT. Observational study with inclusion of consecutive IS patients admitted to an stroke unit. Demographic data, vascular risk factors, comorbidity, stroke severity and 3-month follow-up outcome (modified Rankin Scale) were compared according to prior diagnosis of DM and the use or not of IVT. A total of 1,139 IS patients were admitted; 283 (24.8%) patients had a diagnosis of DM, and 261 were IVT treated (23.2% of the group without DM and 21.9% of the DM group). The IVT-treated patients with DM were older, had more comorbidities and had higher glucose levels on admission than those without DM and than IVT-treated patients. No significant differences in stroke severity, hemorrhagic transformation, in-hospital mortality or outcome at 3 months were found. The logistic regression analysis showed that stroke severity was associated with a higher risk of a poor outcome in IVT-treated patients, with no significant effect from DM after adjustment for confounders. Moreover, IVT was independently associated with a lower risk of poor outcome in DM patients (OR 0.49; 95% CI 0.31-0.76; P = .002). DM patients should not be excluded from IVT, because DM is not associated with a poor outcome after IVT and this treatment is clearly beneficial for DM patients as compared with DM patients not treated with IVT.
对于急性缺血性卒中（IS）患者，糖尿病（DM）患者接受静脉溶栓（IVT）的获益一直受到质疑。我们的目的是分析根据DM的既往诊断以及是否使用IVT，患者在预后方面的差异。对入住卒中单元的连续IS患者进行观察性研究。根据DM的既往诊断以及是否使用IVT，比较人口统计学数据、血管危险因素、合并症、卒中严重程度和3个月随访结果（改良Rankin量表）。共收治1139例IS患者；283例（24.8%）患者诊断为DM，261例接受IVT治疗（非DM组的23.2%以及DM组的21.9%）。与未患DM的患者以及接受IVT治疗的患者相比，接受IVT治疗的DM患者年龄更大，合并症更多，入院时血糖水平更高。在卒中严重程度、出血转化、住院死亡率或3个月时的预后方面未发现显著差异。逻辑回归分析表明，在接受IVT治疗的患者中，卒中严重程度与预后不良风险较高相关，在对混杂因素进行校正后，DM无显著影响。此外，IVT与DM患者预后不良风险较低独立相关（比值比0.49；95%置信区间0.31 - 0.76；P = 0.002）。DM患者不应被排除在IVT治疗之外，因为DM与IVT治疗后的不良预后无关，并且与未接受IVT治疗的DM患者相比，这种治疗对DM患者显然有益。
