School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
Graduate Institute of Clinical Medicine, Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
J Neurol Sci. 2018 May 15;388:195-202. doi: 10.1016/j.jns.2018.03.022. Epub 2018 Mar 16.
Poorly controlled blood glucose was reported to cause deterioration of acute ischemic stroke. In this study, we investigated whether an elevated admission serum glucose level in the 3-h time window of intravenous thrombolysis for acute ischemic stroke determined poor functional outcomes among Chinese population.
This was a prospective cohort study. From December 1, 2004 to December 31, 2016, a total of 2370 patients were enrolled and categorized into two cohorts by blood glucose levels of ≥200 and <200 mg/dl in the 3 h after stroke onset. The primary objective was to determine whether admission hyperglycemia increased major disability and death at 30 and 90 days, which was defined by a modified Rankin Scale of 3-6. The secondary objective was to determine whether admission hyperglycemia increased the symptomatic intracranial hemorrhage (SICH) at 90 days. The number needed to harm (NNH) and patient expected event rate (PEER) were evaluated for both the primary and secondary objectives.
The primary outcome occurred in 216 of 305 patients (70.8%) in the blood glucose ≥200 mg/dl cohort and in 951 of 1587 patients (59.9%) in the blood glucose <200 mg/dl cohort at 30 days, and in 191 of 287 patients (66.6%) in the blood glucose ≥200 mg/dl cohort and in 827 of 1517 patients (54.5%) in the blood glucose <200 mg/dl cohort at 90 days. Patients with admission hyperglycemia had significantly increased major disability and death at 30 (adjusted relative risk (RR): 1.194 [1.073-1.329], p = 0.0012) and 90 days (adjusted RR: 1.203 [1.079-1.340], p = 0.0008). Admission hyperglycemia increased the risk of the occurrence of SICH by nearly 2-fold (adjusted RR: 1.891 [0.977-3.657], p = 0.0585 with the SITS-MOST criteria and adjusted RR: 1.884 [1.138-3.121], p = 0.0139 with the NINDS criteria). NNH values of admission hyperglycemia in major disability and death at 30 and 90 days were 9 and 10, and NNH values of SICH by the SITS-MOST NINDS criteria were 44 and 34, respectively.
The study evidenced the association and temporal relationship of admission hyperglycemia causing deterioration of functional outcomes and increased SICH among Chinese population with acute ischemic stroke treated with intravenous thrombolysis.
有报道称，血糖控制不佳会导致急性缺血性脑卒中病情恶化。本研究旨在探讨中国急性缺血性脑卒中患者静脉溶栓治疗 3 小时内入院时血清葡萄糖水平升高是否与不良功能结局有关。
这是一项前瞻性队列研究。2004 年 12 月 1 日至 2016 年 12 月 31 日，共纳入 2370 例患者，根据发病后 3 小时内血糖水平≥200 和<200mg/dl 将其分为两组。主要目的是确定入院时的高血糖是否会导致 30 天和 90 天的主要残疾和死亡（定义为改良 Rankin 量表 3-6 分）。次要目的是确定入院时的高血糖是否会导致 90 天的症状性颅内出血（SICH）。对主要和次要目标均进行危害比（NNT）和患者预期事件率（PEER）评估。
在 30 天内，血糖≥200mg/dl 组 287 例患者中有 216 例（70.8%）和血糖<200mg/dl 组 1587 例患者中有 951 例（59.9%）发生主要残疾和死亡，在 90 天内，血糖≥200mg/dl 组 287 例患者中有 191 例（66.6%）和血糖<200mg/dl 组 1517 例患者中有 827 例（54.5%）发生主要残疾和死亡。入院时高血糖患者在 30 天（校正相对风险（RR）：1.194 [1.073-1.329]，p=0.0012）和 90 天（校正 RR：1.203 [1.079-1.340]，p=0.0008）时发生主要残疾和死亡的风险显著增加。入院时高血糖使 SICH 的发生风险增加近 2 倍（校正 RR：1.891 [0.977-3.657]，p=0.0585 采用 SITS-MOST 标准和校正 RR：1.884 [1.138-3.121]，p=0.0139 采用 NINDS 标准）。入院时高血糖导致 30 天和 90 天主要残疾和死亡的 NNH 值分别为 9 和 10，采用 SITS-MOST 和 NINDS 标准，SICH 的 NNH 值分别为 44 和 34。
该研究在中国急性缺血性脑卒中患者静脉溶栓治疗中证实了入院时高血糖与功能结局恶化和 SICH 发生率增加之间的关联和时间关系。
