Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
J Am Heart Assoc. 2018 Apr 12;7(8):e008744. doi: 10.1161/JAHA.118.008744.
The purpose of this study was to examine the relationships between glucose parameters obtained by continuous glucose monitoring and clinical outcomes in acute stroke patients.
Consecutive patients with acute ischemic stroke or intracerebral hemorrhage within 24 hours after onset were included. A continuous glucose monitoring device (iPro2) was attached for the initial 72 hours after emergent admission. Eight glucose parameters were obtained from continuous glucose monitoring: maximum, minimum, mean, and SD of blood glucose levels, as well as area under the curve more than 8 mmol/L of blood glucose, distribution time more than 8 mmol/L of blood glucose, coefficient of variation (%CV), and presence of time less than 4 mmol/L over 72 hours. The primary outcome measure was death or dependency at 3 months (modified Rankin Scale score ≥3). One hundred patients with acute ischemic stroke (n=58) or intracerebral hemorrhage (n=42) were included. Blood glucose levels varied between 5.2±1.4 and 11.4±3.2 mmol/L over 72 hours, with area under the curve more than 8 mmol/L of blood glucose of 0.7±1.4 min×mmol/L, distribution time more than 8 mmol/L of blood glucose of 31.7±32.7%, coefficient of variation of 15.5±5.4%, and presence of hypoglycemia in 20% of overall patients. Mean glucose level (adjusted odds ratio, 1.60, 95% confidence interval, 1.12-2.28/1 mmol/L), area under the curve more than 8 mmol/L of blood glucose (2.13, 1.12-4.02/1 min×mmol/L), and distribution time more than 8 mmol/L of blood glucose (1.25, 1.05-1.50/10%) were related to death or dependency for overall patients, as well as for acute ischemic stroke patients (2.05, 1.15-3.65; 2.38, 1.04-5.44; 1.85, 1.10-3.10, respectively).
High mean glucose levels, distribution time more than 8 mmol/L of blood glucose, and areas under the curve more than 8 mmol/L of blood glucose during the initial 72 hours of acute stroke were associated with death or dependency at 3 months.
本研究旨在探讨急性脑卒中患者连续血糖监测获得的血糖参数与临床结局之间的关系。
连续纳入发病后 24 小时内的急性缺血性脑卒中或脑出血患者。在急诊入院后最初的 72 小时内，使用连续血糖监测仪（iPro2）进行监测。从连续血糖监测中获得 8 个血糖参数：血糖水平的最大值、最小值、平均值和标准差，以及血糖超过 8mmol/L 的曲线下面积、血糖超过 8mmol/L 的分布时间、变异系数（%CV）以及 72 小时内血糖低于 4mmol/L 的时间百分比。主要结局测量指标为 3 个月时的死亡或依赖（改良 Rankin 量表评分≥3）。共纳入 100 例急性缺血性脑卒中（n=58）或脑出血（n=42）患者。72 小时内血糖水平在 5.2±1.4 至 11.4±3.2mmol/L 之间，血糖超过 8mmol/L 的曲线下面积为 0.7±1.4min×mmol/L，血糖超过 8mmol/L 的分布时间为 31.7±32.7%，变异系数为 15.5±5.4%，20%的患者出现低血糖。平均血糖水平（调整后的优势比，1.60，95%置信区间，1.12-2.28/1mmol/L）、血糖超过 8mmol/L 的曲线下面积（2.13，1.12-4.02/1min×mmol/L）和血糖超过 8mmol/L 的分布时间（1.25，1.05-1.50/10%）与所有患者以及急性缺血性脑卒中患者的死亡或依赖相关（2.05，1.15-3.65；2.38，1.04-5.44；1.85，1.10-3.10）。
急性脑卒中发病后最初 72 小时内的平均血糖水平较高、血糖超过 8mmol/L 的分布时间较长以及血糖超过 8mmol/L 的曲线下面积较大与 3 个月时的死亡或依赖相关。
