在埃塞俄比亚亚的斯亚贝巴的提克里安贝萨专科医院收治的急性脑卒中患者中，入院高血糖的频率及其对短期预后的影响：一项横断面研究。
The frequency and impact of admission hyperglycemia on short term outcome of acute stroke patients admitted to Tikur Anbessa Specialized hospital, Addis Ababa, Ethiopia: a cross-sectional study.
机构信息
Department of Neurology, College of Health Sciences, Addis Ababa University, P.O.Box: 41690, Addis Ababa, Ethiopia.
Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
出版信息
BMC Neurol. 2019 Dec 27;19(1):342. doi: 10.1186/s12883-019-1578-x.
BACKGROUND
Admission hyperglycemia (HG) has been associated with worse outcomes among acute stroke patients. A better understanding and awareness of the potentially adverse influence of hyperglycemia on the clinical outcome of acute stroke patients would help to provide guidance for acute stroke management and prevention of its adverse outcomes. We aimed to assess the frequency of admission hyperglycemia and its impact on short term (30-days) morbidity and mortality outcomes of stroke in adult Ethiopian patients in an urban setting.
METHODS
A prospective, cross-sectional study was conducted among acute stroke patients admitted to Tikur Anbessa Specialized Hospital (TASH), within 72 h of symptom onset, from July to December 2016. Socio-demographic data, neuroimaging findings and capillary blood glucose values were obtained on admission. Hyperglycemia was defined as > 140 mg/dl. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the baseline stroke severity and the 30-days post-stroke outcome, respectively.
RESULTS
A total of 103 first-ever acute stroke patients were included (mean age = 55.5 + 15.3 years, 64.1% male and 65% under the age of 65 years) and 51 (49.5%) were hyperglycemic at time of admission. The median admission NIHSS score was worse in the hyperglycemic patients 14 (IQR 10-19) compared to normoglycemic patients 11 (IQR 8-15). Among stroke survivors, patients with hyperglycemia were 3.83 times (95% CI, 1.99-6.19) more likely to be functionally impaired (mRS = 3-5) at 30-days compared to normoglycemic patients (P = 0.041).Older age (≥ 65 years) (P = 0.017) and stroke severity (NIHSS > 14) (P = 0.006) at admission were both significantly associated with poor functional recovery at 30-day. Among patients who died at 30-day, two-third (66.7%) were hyperglycemic but they failed to show any significant association.
CONCLUSIONS
Hyperglycemia is prevalent among Ethiopian stroke patients at the time of presentation and it is associated with significantly poor functional recovery at 30-day of follow up. This finding provides a rationale for achieving normal blood glucose in the course of acute stroke management which could have a favorable impact on the neurological outcome and quality of life for patients.
背景
入院时的高血糖（HG）与急性脑卒中患者的预后较差有关。更好地了解和认识高血糖对急性脑卒中患者临床结局的潜在不利影响，有助于为急性脑卒中的管理和预防其不良结局提供指导。我们旨在评估成人埃塞俄比亚患者在城市环境中入院时高血糖的频率及其对脑卒中短期（30 天）发病率和死亡率的影响。
方法
2016 年 7 月至 12 月期间，在症状发作后 72 小时内，对提克里亚斯凡那萨专科医院（TASH）的急性脑卒中患者进行了一项前瞻性、横断面研究。入院时获得了社会人口统计学数据、神经影像学结果和毛细血管血糖值。高血糖定义为>140mg/dl。国立卫生研究院脑卒中量表（NIHSS）和改良 Rankin 量表（mRS）分别用于评估基线脑卒中严重程度和脑卒中后 30 天的结局。
结果
共纳入 103 例首次急性脑卒中患者（平均年龄 55.5+15.3 岁，64.1%为男性，65%年龄在 65 岁以下），51 例（49.5%）入院时高血糖。高血糖组入院 NIHSS 中位数为 14（IQR 10-19），明显高于正常血糖组的 11（IQR 8-15）。在存活的脑卒中患者中，与正常血糖患者相比，高血糖患者在 30 天时更有可能出现功能障碍（mRS=3-5），风险比为 3.83（95%CI，1.99-6.19）（P=0.041）。年龄较大（≥65 岁）（P=0.017）和入院时脑卒中严重程度（NIHSS>14）（P=0.006）与 30 天的功能恢复不良均显著相关。在 30 天内死亡的患者中，三分之二（66.7%）为高血糖患者，但未显示出任何显著关联。
结论
在埃塞俄比亚脑卒中患者就诊时，高血糖很常见，与 30 天的随访时功能恢复不良显著相关。这一发现为急性脑卒中管理过程中实现正常血糖提供了依据，这可能对患者的神经功能结局和生活质量产生有利影响。
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