Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA.
Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.
J Neurol Sci. 2017 Oct 15;381:182-187. doi: 10.1016/j.jns.2017.08.3252. Epub 2017 Aug 30.
Intracerebral hemorrhage (ICH) is associated with poor clinical outcome and high mortality. Sulfonylurea (SFU) use may be a viable therapy for inhibiting sulfonylurea receptor-1 and NC channels and reducing perihematomal edema and blood-brain barrier disruption. We sought to evaluate the effects of prehospital SFU use with outcomes in diabetic patients with acute ICH.
We retrospectively analyzed a cohort of diabetic patients presenting with acute ICH at a tertiary care center. Study inclusion criteria included spontaneous ICH etiology and age>18years. Baseline clinical severity was documented using ICH-score. Hematoma volumes (HV) on admission were calculated using ABC/2 formula. Unfavorable functional outcome was documented as discharge modified Rankin Scale scores 2-6.
230 diabetic patients with acute ICH fulfilled inclusion criteria (mean age 64±13years, men 53%). SFU pretreatment was documented in 16% of the study population. Patients with SFU pretreatment had significantly (p<0.05) lower median ICH-scores (0, IQR: 0-2) and median admission HV (4cm, IQR: 1-12) compared to controls [ICH-score: 1 (IQR: 0-3); HV: 9cm (IQR: 3-20)]. SFU pretreatment was independently (p=0.033) and negatively associated with the cubed root of admission HV (linear regression coefficient: -0.208; 95%CI: -0.398 to -0.017) in multiple linear regression analyses adjusting for potential confounders. Pretreatment with SFU was also independently (p=0.033) associated with lower likelihood of unfavorable functional outcome (OR=0.19; 95%CI: 0.04-0.88) in multivariable logistic regression models adjusting for potential confounders.
SFU pretreatment may be an independent predictor for improved functional outcome in diabetic patients with acute ICH. This association requires independent confirmation in a large prospective cohort study.
脑出血（ICH）与不良临床结局和高死亡率相关。磺酰脲类（SFU）的使用可能是一种可行的治疗方法，可抑制磺酰脲受体-1 和 NC 通道，减少血肿周围水肿和血脑屏障破坏。我们旨在评估院前 SFU 使用对伴有急性 ICH 的糖尿病患者结局的影响。
我们回顾性分析了一家三级医疗中心收治的糖尿病急性 ICH 患者队列。研究纳入标准包括自发性 ICH 病因和年龄>18 岁。基线临床严重程度通过 ICH 评分记录。入院时血肿体积（HV）通过 ABC/2 公式计算。不良功能结局定义为出院时改良 Rankin 量表评分 2-6 分。
230 例符合纳入标准的糖尿病急性 ICH 患者（平均年龄 64±13 岁，男性 53%）。研究人群中，SFU 预处理的比例为 16%。与对照组相比，SFU 预处理患者的 ICH 评分中位数（0，IQR：0-2）和入院 HV 中位数（4cm，IQR：1-12）明显更低（p<0.05）。在调整潜在混杂因素的多元线性回归分析中，SFU 预处理独立（p=0.033）且呈负相关与入院 HV 的立方根（线性回归系数：-0.208；95%CI：-0.398 至-0.017）。在校正潜在混杂因素的多变量逻辑回归模型中，SFU 预处理与不良功能结局的可能性较低独立相关（OR=0.19；95%CI：0.04-0.88）。
SFU 预处理可能是糖尿病急性 ICH 患者功能结局改善的独立预测因素。这一关联需要在大型前瞻性队列研究中独立证实。
