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就诊时高血糖对接受Solitaire支架取栓术治疗的急性大动脉闭塞患者预后的影响。

Effect of Hyperglycemia at Presentation on Outcomes in Acute Large Artery Occlusion Patients Treated With Solitaire Stent Thrombectomy.

作者信息

Huo Xiaochuan, Liu Raynald, Gao Feng, Ma Ning, Mo Dapeng, Liao Xiaoling, Wang Chunjuan, Sun Xuan, Song Ligang, Jia Baixue, Liu Lian, Wang Bo, Pan Yuesong, Wang Yilong, Liu Liping, Zhao Xingquan, Wang Yongjun, Miao Zhongrong

机构信息

Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

出版信息

Front Neurol. 2019 Feb 19;10:71. doi: 10.3389/fneur.2019.00071. eCollection 2019.

Abstract

Sporadic data showed hyperglycemia at presentation is associated with poor outcomes in patients with acute ischemic stroke (AIS) under mechanical thrombectomy (MT) treatment. This study aims to evaluate the relationship of admission hyperglycemia and outcomes in patients treated with solitaire stent thrombectomy. This multicenter prospective study registered patients with AIS due to anterior circulation large vessel occlusion (LVO) suitable for MT with Solitaire stent retriever. We analyzed the influence of admission hyperglycemia (≥7.8 mmol/L) and serum glucose on functional independence which is defined as modified Rankin Scale score (mRS) of 0-2, symptomatic intracranial hemorrhage (sICH) and several outcomes of interest using univariable and multiple logistic regression analysis. This study involved 17 stroke centers across China and consecutively recruited 149 patients. Patients with hyperglycemia at presentation less frequently exhibited a functional independence at 3 months than patients without hyperglycemia (22.2 vs. 66.4%; odds ratio 0.75, 95% confidence interval 0.61-0.92; = 0.005). Higher glucose levels were correlated with worse outcome (per 1 mmol/L increase in glucose: odds ratio for mRS score 0-2 at 3 months 0.17, 95% confidence interval 0.06-0.45; < 0.001) at 3 months and sICH (per 1 mmol/L increase in glucose: odds ratio for sICH was 8.2, 95% confidence interval 1.13-29.57; < 0.001) after thrombectomy. Higher admission serum glucose and hyperglycemia were independently correlated with lower functional independence at 3 months in patients treated with Solitaire stent thrombectomy of anterior circulation LVO. Higher admission serum glucose was also associated with sICH after thrombectomy.

摘要

零星数据显示,在接受机械取栓(MT)治疗的急性缺血性卒中(AIS)患者中,就诊时高血糖与不良预后相关。本研究旨在评估接受Solitaire支架取栓治疗患者的入院高血糖与预后之间的关系。这项多中心前瞻性研究纳入了因前循环大血管闭塞(LVO)而适合使用Solitaire支架取栓器进行MT治疗的AIS患者。我们使用单变量和多变量逻辑回归分析,分析了入院高血糖(≥7.8 mmol/L)和血糖对功能独立性(定义为改良Rankin量表评分[mRS]为0 - 2)、症状性颅内出血(sICH)以及其他几个感兴趣结局的影响。本研究涉及中国17个卒中中心,连续招募了149例患者。就诊时高血糖的患者在3个月时功能独立的频率低于无高血糖的患者(22.2%对66.4%;优势比0.75,95%置信区间0.61 - 0.92;P = 0.005)。更高的血糖水平与3个月时更差的预后相关(血糖每升高1 mmol/L:3个月时mRS评分0 - 2的优势比为0.17,95%置信区间0.06 - 0.45;P < 0.001),以及与取栓术后的sICH相关(血糖每升高1 mmol/L:sICH的优势比为8.2,95%置信区间1.13 - 至29.57;P < 0.001)。对于接受前循环LVO的Solitaire支架取栓治疗的患者,入院时更高的血清葡萄糖和高血糖与3个月时更低的功能独立性独立相关。入院时更高的血清葡萄糖也与取栓术后的sICH相关。

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