Goldman Myla D, Koenig Scott, Engel Casey, McCartney Christopher R, Sohn Min-Woong
Department of Neurology (M.D.G.), Division of Endocrinology and Metabolism, Department of Medicine (C.R.M.), and Department of Public Health Sciences (M.-W.S.), University of Virginia School of Medicine, Charlottesville; University of Maryland School of Medicine (S.K.), Baltimore; and University of Virginia College of Arts and Sciences (C.E.), Charlottesville.
Neurol Neuroimmunol Neuroinflamm. 2017 Jul 18;4(5):e378. doi: 10.1212/NXI.0000000000000378. eCollection 2017 Sep.
To determine the relationship between MS relapse recovery and blood glucose (BG) response to IV methylprednisolone (IVMP) treatment.
We retrospectively identified 36 patients with MS admitted for IVMP treatment of acute relapse who had adequate data to characterize BG response, relapse severity, and recovery. The relationship between glucocorticoid-associated nonfasting BG (NFBG) and relapse recovery was assessed.
Highest recorded nonfasting BG (maximum NFBG [maxNFBG]) values were significantly higher in patients with MS without relapse recovery compared with those with recovery (271 ± 68 vs 209 ± 48 mg/dL, respectively; = 0.0045). After adjusting for relapse severity, MS patients with maxNFBG below the group median were 6 times (OR = 6.01; 95% CI, 1.08-33.40; = 0.040) more likely to experience relapse recovery than those with maxNFBG above the group median. In a multiple regression model adjusting for age, sex, and relapse severity, a 1-mg/dL increase in the maxNFBG was associated with 4.5% decrease in the probability of recovery (OR = 0.955; 95% CI, 0.928-0.983; = 0.002).
These findings suggest that higher glucocorticoid-associated NFBG values in acutely relapsing patients with MS are associated with diminished probability of recovery. This relationship could reflect steroid-associated hyperglycemia and/or insulin resistance, defects in non-steroid-associated (e.g., prerelapse) glucose metabolism, or both. This study included only those admitted for an MS relapse, and it is this subset of patients for whom these findings may be most relevant. A prospective study to evaluate glucose regulation and MS relapse recovery in a broader outpatient MS population is under way.
确定多发性硬化症（MS）复发恢复与静脉注射甲泼尼龙（IVMP）治疗后血糖（BG）反应之间的关系。
我们回顾性地确定了36例因急性复发接受IVMP治疗的MS患者，这些患者有足够的数据来描述BG反应、复发严重程度和恢复情况。评估了糖皮质激素相关的非空腹血糖（NFBG）与复发恢复之间的关系。
与复发恢复的患者相比，未复发恢复的MS患者记录到的最高非空腹血糖（最大NFBG [maxNFBG]）值显著更高（分别为271±68与209±48 mg/dL；P = 0.0045）。在调整复发严重程度后，maxNFBG低于组中位数的MS患者复发恢复的可能性是maxNFBG高于组中位数患者的6倍（OR = 6.01；95% CI，1.08 - 33.40；P = 0.040）。在调整年龄、性别和复发严重程度的多元回归模型中，maxNFBG每增加1 mg/dL，恢复概率降低4.5%（OR = 0.955；95% CI，0.928 - 0.983；P = 0.002）。
这些发现表明，急性复发的MS患者中较高的糖皮质激素相关NFBG值与恢复概率降低有关。这种关系可能反映了类固醇相关的高血糖和/或胰岛素抵抗、非类固醇相关（如复发前）葡萄糖代谢缺陷，或两者兼而有之。本研究仅纳入了因MS复发入院的患者，这些发现可能对这一患者亚组最为相关。一项评估更广泛门诊MS人群中葡萄糖调节和MS复发恢复的前瞻性研究正在进行中。
