静脉溶栓治疗后的入院高血糖与预后：卒中亚型之间存在差异吗？
Admission hyperglycemia and outcome after intravenous thrombolysis: is there a difference among the stroke-subtypes?
作者信息
Miedema Irene, Luijckx Gert-Jan, Brouns Raf, De Keyser Jacques, Uyttenboogaart Maarten
机构信息
Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
Department of Neurology, Universitair Ziekenhuis Brussel, Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
出版信息
BMC Neurol. 2016 Jul 15;16:104. doi: 10.1186/s12883-016-0617-0.
BACKGROUND
The prognostic influence of hyperglycemia in acute stroke has been well established. While in cortical stroke there is a strong association between hyperglycemia and poor outcome, this relation is less clear in lacunar stroke. It has been suggested that this discrepancy is present among patients treated with intravenous tissue plasminogen activator (tPA), but confirmation is needed.
METHODS
In two prospectively collected cohorts of patient treated with intravenous tPA for acute ischemic stroke, we investigated the effect of hyperglycemia (serum glucose level >8 mmol/L) on functional outcome in lacunar and non-lacunar stroke. Poor functional outcome was defined as modified Rankin Scale score ≥ 3 at 3 months.
RESULTS
A total of 1012 patients was included of which 162 patients (16%) had lacunar stroke. The prevalence of hyperglycemia did not differ between stroke subtypes (22% vs 21%, p = 0.85). In multivariate analysis hyperglycemia was associated with poor functional outcome in non-lacunar stroke (OR 2.1, 95% CI 1.39-3.28, p = 0.001). In patients with lacunar stroke, we did not find an association (OR 1.8, 95% CI 0.62-4.08, p = 0.43).
CONCLUSION
This study confirms a difference in prognostic influence of hyperglycemia between non-lacunar and lacunar ischemic stroke.
背景
高血糖在急性卒中中的预后影响已得到充分证实。在皮质卒中中，高血糖与不良预后之间存在密切关联，但在腔隙性卒中中这种关系尚不清楚。有人提出，这种差异在接受静脉注射组织纤溶酶原激活剂（tPA）治疗的患者中存在，但仍需证实。
方法
在两个前瞻性收集的接受静脉tPA治疗急性缺血性卒中的患者队列中，我们研究了高血糖（血清葡萄糖水平>8 mmol/L）对腔隙性卒中和非腔隙性卒中功能结局的影响。不良功能结局定义为3个月时改良Rankin量表评分≥3分。
结果
共纳入1012例患者，其中162例（16%）为腔隙性卒中。卒中亚型之间高血糖的患病率无差异（22%对21%，p = 0.85）。多变量分析显示，高血糖与非腔隙性卒中的不良功能结局相关（比值比2.1，95%置信区间1.39 - 3.28，p = 0.001）。在腔隙性卒中患者中未发现相关性（比值比1.8，95%置信区间0.62 - 4.08，p = 0.43）。
结论
本研究证实了非腔隙性和腔隙性缺血性卒中在高血糖预后影响方面的差异。
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