Jing Jing, Pan Yuesong, Zhao Xingquan, Zheng Huaguang, Jia Qian, Li Hao, Guan Ling, Liu Liping, Wang Chunxue, Meng Xia, He Yan, Wang Yilong, Wang Yongjun
From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (J.J., Y.P., X.Z., H.Z., Q.J., H.L., L.L., C.W., X.M., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., Y.P., X.Z., H.Z., Q.J., H.L., L.L., C.W., X.M., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (J.J., Y.P., X.Z., H.Z., Q.J., H.L., L.L., C.W., X.M., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., Y.P., X.Z., H.Z., Q.J., H.L., L.L., C.W., X.M., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China (Y.P., Y.H.); and Department of Medicine, University of British Columbia, Vancouver, Canada (L.G.).
Stroke. 2016 Aug;47(8):2038-44. doi: 10.1161/STROKEAHA.116.013606. Epub 2016 Jul 5.
Hemoglobin A1c (HbA1c) was recommended to diagnose diabetes mellitus, but whether newly diagnosed diabetes mellitus (NDDM) according to the new criteria was associated with stroke prognosis was unclear. We aimed to investigate the prognosis of ischemic stroke with NDDM according to the new criteria.
Ischemic stroke without a diabetes mellitus history in the survey on Abnormal Glucose Regulation in Patients With Acute Stroke Across China were included in the analysis. NDDM was defined as fasting plasma glucose ≥7.0 mmol/L, 2-hour oral glucose tolerance test ≥11.1 mmol/L, or HbA1c ≥6.5%, and NDDM was divided into group 1, diagnosed by glucose criteria (fasting plasma glucose ≥7.0 mmol/L or 2-hour oral glucose tolerance test ≥11.1 mmol/L with/without HbA1c ≥6.5%), or group 2, diagnosed by single high HbA1c (fasting plasma glucose <7.0 mmol/L, 2-hour oral glucose tolerance test <11.1 mmol/L, and HbA1c ≥6.5%). The association between NDDM and 1-year prognosis (mortality, stroke recurrence, and poor functional outcome [modified Rankin scale score 3-6]) was estimated.
Among 1251 ischemic stroke patients, 539 were NDDM and 141 of NDDM with single high HbA1c. NDDM was an independent risk factor for 1-year mortality (hazard ratio, 1.12; 95% confidence interval, 1.001-1.26), stroke recurrence (hazard ratio, 1.14; 95% confidence interval, 1.01-1.28), and poor functional outcome (odds ratio, 2.58; 95% confidence interval, 1.95-3.43) compared with non-diabetes mellitus. Nevertheless, NDDM with single high HbA1c was not significantly associated with 1-year prognosis for all end points (P>0.05 for all).
NDDM by new criteria was associated with poor prognosis at 1 year after ischemic stroke; however, NDDM with single high HbA1c did not predict a poor prognosis.
血红蛋白A1c（HbA1c）被推荐用于诊断糖尿病，但根据新诊断标准诊断的新诊断糖尿病（NDDM）是否与卒中预后相关尚不清楚。我们旨在根据新诊断标准研究NDDM患者缺血性卒中的预后。
纳入“中国急性卒中患者糖代谢异常调查”中无糖尿病病史的缺血性卒中患者进行分析。NDDM定义为空腹血糖≥7.0 mmol/L、口服葡萄糖耐量试验2小时血糖≥11.1 mmol/L或HbA1c≥6.5%，NDDM又分为第1组，通过血糖标准诊断（空腹血糖≥7.0 mmol/L或口服葡萄糖耐量试验2小时血糖≥11.1 mmol/L，无论HbA1c是否≥6.5%），或第2组，通过单纯HbA1c升高诊断（空腹血糖<7.0 mmol/L，口服葡萄糖耐量试验2小时血糖<11.1 mmol/L，且HbA1c≥6.5%）。评估NDDM与1年预后（死亡率、卒中复发及功能预后不良[改良Rankin量表评分3 - 6分]）之间的关联。
在1251例缺血性卒中患者中，539例为NDDM，其中141例为单纯HbA1c升高的NDDM。与非糖尿病患者相比，NDDM是1年死亡率（风险比，1.12；95%置信区间，1.001 - 1.26）、卒中复发（风险比，1.14；95%置信区间，1.01 - 1.28）及功能预后不良（比值比，2.58；95%置信区间，1.95 - 3.43）的独立危险因素。然而，单纯HbA1c升高的NDDM与所有终点的1年预后均无显著关联（所有P>0.05）。
根据新诊断标准诊断的NDDM与缺血性卒中后1年预后不良相关；然而，单纯HbA1c升高的NDDM并不能预测预后不良
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