Cerebral Vascular Disease Research Laboratories, Miller 12235 School of Medicine, University of Miami , Miami, FL, USA.
Department of Neurology, Miller 12235 School of Medicine, University of Miami , Miami, FL, USA.
Int J Stroke. 2020 Jul;15(5):477-483. doi: 10.1177/1747493017743797. Epub 2017 Nov 14.
Hemorrhagic transformation is a severe complication of acute ischemic stroke owing to its limited treatment options and poor prognosis. In the last decade, the rates of hemorrhagic transformation incidence have been associated with blood glucose levels. In particular, hyperglycemia at the time of admission has been associated with increased rates of hemorrhagic transformation in acute ischemic stroke patients. Recent pilot clinical trials have attempted to use intensive insulin therapy during stroke treatment to reduce the severity of cerebral infarction and possibly alleviate the risk of hemorrhagic transformation. However, the results of these studies have shown no clear clinical benefit. In addition, intensive insulin therapy has increased rates of hypoglycemia which may be associated with larger infarct growth. We hypothesize that hypoglycemia, similarly to hyperglycemia, is a risk factor for worse outcomes in acute ischemic stroke by promoting hemorrhagic transformation. This review serves to call attention to patterns present within intensive insulin therapy trials and shed light into the pathophysiological effects of hypoglycemia. It is critical that efforts be directed toward the prevention of hemorrhagic transformation by optimizing insulin therapy during the treatment of acute ischemic stroke.
出血转化是急性缺血性卒中的一种严重并发症，其治疗选择有限，预后较差。在过去十年中，出血转化的发生率与血糖水平有关。具体来说，入院时的高血糖与急性缺血性卒中患者出血转化发生率的增加有关。最近的一些试点临床试验试图在卒中治疗期间使用强化胰岛素治疗来减轻脑梗死的严重程度，并可能降低出血转化的风险。然而，这些研究的结果并没有显示出明显的临床获益。此外，强化胰岛素治疗增加了低血糖的发生率，而低血糖可能与更大的梗死灶生长有关。我们假设，低血糖与高血糖一样，通过促进出血转化，是急性缺血性卒中不良结局的一个危险因素。本综述旨在提请人们注意强化胰岛素治疗试验中存在的模式，并阐明低血糖的病理生理影响。通过优化急性缺血性卒中治疗期间的胰岛素治疗来预防出血转化至关重要。
