胰岛素在急性缺血性卒中治疗中的应用：一项系统评价与荟萃分析

Insulin in the Management of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

作者信息

Cerecedo-Lopez Christian D, Cantu-Aldana Alejandra, Patel Nirav J, Aziz-Sultan M Ali, Frerichs Kai U, Du Rose

机构信息

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Facultad de Ciencias de la Salud, Universidad Anáhuac México, Huixquilucan, Estado de México, México.

出版信息

World Neurosurg. 2020 Apr;136:e514-e534. doi: 10.1016/j.wneu.2020.01.056. Epub 2020 Jan 16.

DOI:10.1016/j.wneu.2020.01.056

PMID:31954893

Abstract

OBJECTIVE

The role of tight glycemic control in the management of acute ischemic stroke remains uncertain. Our goal is to evaluate the effects of tight glucose control with insulin therapy after acute ischemic stroke.

METHODS

We searched PubMed, CENTRAL, and Embase for randomized controlled trials (RCTs) that evaluated the effects of tight glycemic control (70-135 mg/dL) in acute ischemic stroke. Analysis was performed using fixed-effects and random-effects models. Outcomes were death, independence, and modified Rankin Scale (mRS) score at ≥90 days follow-up, and symptomatic or severe hypoglycemia during treatment.

RESULTS

Twelve RCTs including 2734 patients were included. Compared with conventional therapy or placebo, tight glycemic control was associated with similar rates of mortality at ≥90 days follow-up (pooled odds ratio [pOR], 0.99; 95% confidence interval [CI], 0.79-1.22]; I = 0%), independence at ≥90 days follow-up (pOR, 0.95; 95% CI, 0.79-1.14; I = 0%) and mRS scores at ≥90 days follow-up (standardized mean difference, 0.014; 95% CI, -0.15 to 0.17; I = 0%). In contrast, tight glycemic control was associated with increased rates of symptomatic or severe hypoglycemia during treatment (pOR, 5.2; 95% CI, 1.7-15.9; I = 28%).

CONCLUSIONS

Tight glucose control after acute ischemic stroke is not associated with improvements in mortality, independence, or mRS score and leads to higher rates of symptomatic or severe hypoglycemia.

摘要

目的

严格血糖控制在急性缺血性脑卒中管理中的作用仍不明确。我们的目标是评估急性缺血性脑卒中后胰岛素治疗严格控制血糖的效果。

方法

我们检索了PubMed、CENTRAL和Embase数据库，查找评估急性缺血性脑卒中严格血糖控制（70 - 135 mg/dL）效果的随机对照试验（RCT）。使用固定效应模型和随机效应模型进行分析。结局指标为随访≥90天时的死亡、独立生活能力以及改良Rankin量表（mRS）评分，以及治疗期间的症状性或严重低血糖。

结果

纳入了12项RCT，共2734例患者。与传统治疗或安慰剂相比，严格血糖控制在随访≥90天时的死亡率（合并比值比[pOR]，0.99；95%置信区间[CI]，0.79 - 1.22；I² = 0%）、随访≥90天时的独立生活能力（pOR，0.95；95% CI，0.79 - 1.14；I² = 0%）和随访≥90天时的mRS评分（标准化均差，0.014；95% CI， - 0.15至0.17；I² = 0%）方面并无差异。相比之下，严格血糖控制与治疗期间症状性或严重低血糖发生率增加相关（pOR，5.2；95% CI，1.7 - 15.9；I² = 28%）。