急性缺血性脑卒中患者的入院血糖及动脉内治疗效果
Admission Glucose and Effect of Intra-Arterial Treatment in Patients With Acute Ischemic Stroke.
作者信息
Osei Elizabeth, den Hertog Heleen M, Berkhemer Olvert A, Fransen Puck S S, Roos Yvo B W E M, Beumer Debbie, van Oostenbrugge Robert J, Schonewille Wouter J, Boiten Jelis, Zandbergen Adrienne A M, Koudstaal Peter J, Dippel Diederik W J
机构信息
From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.).
出版信息
Stroke. 2017 May;48(5):1299-1305. doi: 10.1161/STROKEAHA.116.016071. Epub 2017 Apr 7.
BACKGROUND AND PURPOSE
Hyperglycemia on admission is common after ischemic stroke. It is associated with unfavorable outcome after treatment with intravenous thrombolysis and after intra-arterial treatment. Whether hyperglycemia influences the effect of reperfusion treatment is unknown. We assessed whether increased admission serum glucose modifies the effect of intra-arterial treatment in patients with acute ischemic stroke.
METHODS
We used data from the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). Hyperglycemia was defined as admission serum glucose >7.8 mmol/L. The primary outcome measure was the adjusted common odds ratio for a shift in the direction of a better outcome on the modified Rankin Scale at 90 days, estimated with ordinal logistic regression. Secondary outcome variable was symptomatic intracranial hemorrhage. We assessed treatment effect modification of hyperglycemia and admission serum glucose levels with multiplicative interaction factors and adjusted for prognostic variables.
RESULTS
Four hundred eighty-seven patients were included. Mean admission serum glucose was 7.2 mmol/L (SD, 2.2). Fifty-seven of 226 patients (25%) randomized to intra-arterial treatment were hyperglycemic compared with 61 of 261 patients (23%) in the control group. The interaction of either hyperglycemia or admission serum glucose levels and treatment effect on modified Rankin Scale scores was not significant (=0.67 and =0.87, respectively). The same applied for occurrence of symptomatic hemorrhage (=0.39 for hyperglycemia, =0.39 for admission serum glucose).
CONCLUSIONS
We found no evidence for effect modification of intra-arterial treatment by admission serum glucose in patients with acute ischemic stroke.
CLINICAL TRIAL REGISTRATION
URL: www.isrctn.com. Unique identifier: ISRCTN10888758.
背景与目的
缺血性卒中后入院时高血糖很常见。它与静脉溶栓治疗及动脉内治疗后的不良预后相关。高血糖是否影响再灌注治疗效果尚不清楚。我们评估了入院时血清葡萄糖升高是否会改变急性缺血性卒中患者动脉内治疗的效果。
方法
我们使用了来自MR CLEAN（荷兰急性缺血性卒中血管内治疗多中心随机临床试验）的数据。高血糖定义为入院时血清葡萄糖>7.8 mmol/L。主要结局指标是通过有序逻辑回归估计的90天时改良Rankin量表上向更好预后方向转变的校正共同比值比。次要结局变量是症状性颅内出血。我们用乘法交互因子评估高血糖和入院血清葡萄糖水平对治疗效果的修正，并对预后变量进行校正。
结果
纳入487例患者。平均入院血清葡萄糖为7.2 mmol/L（标准差，2.2）。随机接受动脉内治疗的226例患者中有57例（25%）为高血糖，而对照组261例患者中有61例（23%）为高血糖。高血糖或入院血清葡萄糖水平与治疗效果对改良Rankin量表评分的交互作用均不显著（分别为=0.67和=0.87）。症状性出血的情况也是如此（高血糖为=0.39，入院血清葡萄糖为=0.39）。
结论
我们没有发现证据表明急性缺血性卒中患者入院时血清葡萄糖会改变动脉内治疗的效果。
Zotero 插件