Tsivgoulis Georgios, Goyal Nitin, Iftikhar Sulaiman, Zand Ramin, Chang Jason J, Elijovich Lucas, Alexandrov Anne W, Malkoff Marc D, Alexandrov Andrei V
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee; Second Department of Neurology, "Attikon University Hospital", School of Medicine, University of Athens, Athens, Greece.
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.
J Stroke Cerebrovasc Dis. 2017 Apr;26(4):795-800. doi: 10.1016/j.jstrokecerebrovasdis.2016.10.019. Epub 2016 Nov 16.
Preliminary studies have indicated that sulfonylurea drugs (SUD) may confer protection against cerebral swelling and hemorrhagic transformation in severe acute ischemic stroke (AIS). We sought to determine whether pretreatment and in-hospital use of SUD may be associated with better outcomes in diabetic AIS patients treated with intravenous thrombolysis (IVT).
We analyzed consecutive diabetic AIS patients treated with IVT during a 3-year period. Pretreatment with SUD, admission NIHSS (National Institutes of Health Stroke Scale) score, NIHSS at 48 hours, and modified Rankin Scale (mRS) at discharge were documented. Patients who discontinued SUD during hospitalization were excluded. Symptomatic intracranial hemorrhage (sICH) was defined as imaging evidence of ICH with NIHSS score increase of greater than or equal to 4 points within 72 hours. Early neurological improvement was defined as an NIHSS score decrease of greater than or equal to 4 points or NIHSS score of 0 at 48 hours. Cerebral edema was documented by neuroradiology reports. Favorable functional outcome (FFO) was defined as discharge mRS of 0-1.
A total of 148 diabetic AIS patients were evaluated (mean age 64 ± 11 years, 49% men, median admission NIHSS score: 8 points). We identified 42 (28%) cases pretreated with SUD. The prevalence of complications and favorable outcomes did not differ (P > .1) between patients pretreated and nonpretreated with SUD: sICH (2% versus 5%), cerebral edema (5% versus 4%), early neurological improvement (42% versus 43%), in-hospital mortality (12% versus 5%), and FFO (22% versus 32%).
Pretreatment and in-hospital use of SUD appears not to be associated with early favorable outcomes and lower likelihood of potential complications in diabetic AIS patients treated with IVT.
初步研究表明，磺脲类药物（SUD）可能对严重急性缺血性卒中（AIS）的脑肿胀和出血性转化具有保护作用。我们旨在确定SUD的预处理及住院期间使用是否与接受静脉溶栓（IVT）治疗的糖尿病AIS患者的更好预后相关。
我们分析了3年内接受IVT治疗的连续性糖尿病AIS患者。记录SUD的预处理情况、入院时美国国立卫生研究院卒中量表（NIHSS）评分、48小时时的NIHSS评分以及出院时的改良Rankin量表（mRS）评分。排除住院期间停用SUD的患者。症状性颅内出血（sICH）定义为颅内出血的影像学证据，且在72小时内NIHSS评分增加大于或等于4分。早期神经功能改善定义为48小时时NIHSS评分降低大于或等于4分或NIHSS评分为0。脑水肿通过神经放射学报告记录。良好功能预后（FFO）定义为出院时mRS为0 - 1分。
共评估了148例糖尿病AIS患者（平均年龄64±11岁，49%为男性，入院时NIHSS评分中位数：8分）。我们确定了42例（28%）接受SUD预处理的病例。SUD预处理组和未预处理组患者的并发症发生率和良好预后情况无差异（P＞0.1）：sICH（2%对5%）、脑水肿（5%对4%）、早期神经功能改善（42%对43%）、住院死亡率（12%对5%）以及FFO（22%对32%）。
在接受IVT治疗的糖尿病AIS患者中，SUD的预处理及住院期间使用似乎与早期良好预后及潜在并发症的较低发生率无关。
