Stroke Unit - University Hospital of Nice (France), Pasteur(2) Hospital, 30 Voie romaine, 06000 Nice, France; Université Côte d'Azur (UCA), 28 Avenue de Valrose, 06100 Nice, France; Laboratoire TIRO, UMR E4320, Faculté de Médecine, 28 Avenue de Valombrose, 06107 Nice Cedex 2, France.
Stroke Unit - University Hospital of Nice (France), Pasteur(2) Hospital, 30 Voie romaine, 06000 Nice, France; Université Côte d'Azur (UCA), 28 Avenue de Valrose, 06100 Nice, France.
Clin Neurol Neurosurg. 2020 Jul;194:105750. doi: 10.1016/j.clineuro.2020.105750. Epub 2020 Feb 26.
Admission hyperglycemia is a penumbra-modifying factor that is associated with poor functional outcome in acute ischemic stroke (AIS) patients treated with intravenous rt-PA and/or mechanical thrombectomy (MT). Insulin therapy has failed to demonstrate a clinical benefit and the question of the patient selection remains under debate. We assessed the relationship between admission glycemia (AG) and functional outcome in AIS patients treated by MT according to both penumbra characteristics and reperfusion status.
We performed a retrospective analysis of a multi-center registry of consecutive AIS (NIHSS ≥ 10) due to middle cerebral artery occlusion treated by MT (± tissue Plasminogen Activator (tPA)). To evaluate the association between AG and the 3-month functional outcome (modified Rankin Scale (mRS) ≤2), univariable and multivariable analyses were used. Subgroup analyses were performed according to both clinical-ASPECTS Mismatch (CAM2) and the complete recanalization (CR) status defined by a mTICI scale (modified Thrombolysis in Cerebral Infarction) 2b/3.
216 AIS patients were included (Median Age: 68.43[58.12-77.95], median NIHSS: 18[15-21]). 104/216 (48.15%) patients had mRS≤2 at 3 months. AG was an independent predictor of functional outcome (/1 g/L OR: 0.10[0.03-0.37]) after adjusting for potential cofounders. Among subgroups formed by combining CAM2 and CR, AG was found to be predictor of functional outcome only in CAM2/CR and specifically when recanalization was early.
This study highlights the fact that the relationship between AG and prognosis is not homogeneous for all patients and indicates that AG has a deleterious effect on the ischemic penumbra, thus explaining its statistical association with functional outcome. Stroke neuroprotection by targeting hyperglycemia should be considered in acute stroke patients with mismatch and early complete recanalization. More prospective randomized trials are needed to generalize the conclusions.
入院时的高血糖是一种半暗带修饰因子，与接受静脉 rt-PA 和/或机械取栓 (MT) 治疗的急性缺血性脑卒中 (AIS) 患者的不良功能结局相关。胰岛素治疗未能显示出临床获益，患者选择的问题仍存在争议。我们根据半暗带特征和再灌注状态，评估了接受 MT 治疗的 AIS 患者入院血糖 (AG) 与功能结局之间的关系。
我们对多中心连续 AIS (NIHSS≥10) 患者进行了回顾性分析，这些患者因大脑中动脉闭塞而接受 MT(±组织纤溶酶原激活物 (tPA)) 治疗。为了评估 AG 与 3 个月时的功能结局 (改良 Rankin 量表 (mRS) ≤2) 之间的关系，进行了单变量和多变量分析。根据临床-ASPECTS 不匹配 (CAM2) 和由 mTICI 量表 (改良脑梗死溶栓) 定义的完全再通 (CR) 状态进行了亚组分析。
纳入了 216 例 AIS 患者 (中位年龄：68.43[58.12-77.95]，中位 NIHSS：18[15-21])。216 例患者中有 104 例 (48.15%) 在 3 个月时 mRS≤2。在调整了潜在混杂因素后，AG 是功能结局的独立预测因素 (/1 g/L OR：0.10[0.03-0.37])。在结合 CAM2 和 CR 形成的亚组中，AG 仅在 CAM2/CR 中是功能结局的预测因素，特别是在再通早期时。
这项研究强调了一个事实，即 AG 与预后之间的关系并非对所有患者都是一致的，并表明 AG 对半暗带具有有害影响，从而解释了其与功能结局的统计学关联。针对高血糖的卒中神经保护治疗应该在存在不匹配和早期完全再通的急性卒中患者中考虑。需要更多的前瞻性随机试验来推广这些结论。
