Roquer Jaume, Giralt-Steinhauer Eva, Cerdà Georgina, Rodríguez-Campello Ana, Cuadrado-Godia Elisa, Jiménez-Conde Jordi, Vivanco-Hidalgo Rosa Maria, Soriano Carol, Dégano Irene R, Ois Angel
Servei de Neurologia, Hospital del Mar, Barcelona, Spain.
Cerebrovasc Dis. 2015;40(5-6):244-50. doi: 10.1159/000440735. Epub 2015 Oct 21.
Hyperglycemia is a marker of poor outcome in acute ischemic stroke (IS) patients. We aimed at evaluating the effect of combined HbA1c and first glucose measurement values on 3-month mortality prediction.
In a prospective analysis, 1,317 first-ever IS patients with HbA1c values were classified by first glycemia value (<155, 155-199, ≥200 mg/dl). Three-month mortality was analyzed by glycemia category in nondiabetics, diabetics with good previous glucose control (PGC) (HbA1c <7%), and diabetics with poor PGC (HbA1c ≥7.0%).
Mortality at 3 months was 13.1%, with no differences (p = 0.339) between non-diabetes mellitus (DM) (12.3%), good PGC-DM (12.4%), and poor PGC-DM (15.6%) patients. The unadjusted relative risk of 3-month mortality for patients with glucose ≥200 mg/dl was 3.76 (95% CI 1.48-9.56) in non-DM, 6.10 (95% CI 1.76-21.09) in good PGC-DM, and 1.44 (95% CI 0.77-2.69) in poor PGC-DM. Glycemia cutoffs most highly correlated with mortality increased as PGC declined: 107 mg/dl in non-DM, 152 mg/dl in good PGC-DM, and 229 mg/dl in poor PGC-DM patients. Glycemia correlated with stroke severity in nondiabetics and diabetic patients with good PGC, but not in those with poor PGC.
HbA1c determination combined with first measured glucose value is useful to stratify mortality risk in IS patients: hyperglycemia is a poor prognostic marker in non-DM and DM patients with good PGC; results are inconsistent in poor PGC-DM patients. Our data suggest the relationship between hyperglycemia and poor outcome reflects stress response rather than a deleterious effect of glucose.
高血糖是急性缺血性卒中（IS）患者预后不良的一个指标。我们旨在评估糖化血红蛋白（HbA1c）与首次血糖测量值相结合对3个月死亡率预测的影响。
在一项前瞻性分析中，1317例首次发生IS且有HbA1c值的患者按首次血糖值（<155、155 - 199、≥200mg/dl）进行分类。对非糖尿病患者、既往血糖控制良好（PGC）（HbA1c <7%）的糖尿病患者以及PGC差（HbA1c≥7.0%）的糖尿病患者，按血糖类别分析3个月死亡率。
3个月时的死亡率为13.1%，非糖尿病（DM）患者（12.3%）、PGC良好的DM患者（12.4%）和PGC差的DM患者（15.6%）之间无差异（p = 0.339）。血糖≥200mg/dl的患者，3个月死亡率的未调整相对风险在非DM患者中为3.76（95%CI 1.48 - 9.56），在PGC良好的DM患者中为6.10（95%CI 1.76 - 21.09），在PGC差的DM患者中为1.44（95%CI 0.77 - 2.69）。与死亡率相关性最高的血糖临界值随PGC下降而升高：非DM患者中为107mg/dl，PGC良好的DM患者中为152mg/dl，PGC差的DM患者中为229mg/dl。血糖与非糖尿病患者以及PGC良好的糖尿病患者的卒中严重程度相关，但与PGC差的患者无关。
HbA1c测定与首次测量的血糖值相结合有助于对IS患者的死亡风险进行分层：高血糖在非DM患者和PGC良好的DM患者中是预后不良的指标；在PGC差的DM患者中结果不一致。我们的数据表明高血糖与不良预后之间的关系反映的是应激反应而非葡萄糖的有害作用。
