卒中前二甲双胍使用与卒中严重程度和溶栓结局的相关性。
Association of prestroke metformin use, stroke severity, and thrombolysis outcome.
机构信息
From the Department of Neurology (L.P.W., R.W., A.R.L., S.W.), University Hospital Zurich; Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics (U.H., K.S.), University of Zurich, Switzerland; Department of Neurology (C.H., P.R.), University Hospital Heidelberg, Germany; Department of Neurology (S.C., N.M.-M., M.T.), University of Helsinki and Helsinki University Hospital, Finland; Department of Neurology and Center for Stroke Research (C.H.N., J.F.S., H.E.), Charité University Hospital, Berlin, Germany; Stroke Center and Neurology (A.A.P., C.T., H.G., S.T.E.), University Hospital Basel and University Basel; Department of Neurology (A.E., P.M.), University Hospital Lausanne; Department of Neurology (M.R.H., M.A.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Stroke Center (A.Z.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital; Stroke Unit (L.V.), Department of Neuroscience, S'Agostino-Estense Hospital, Modena University Hospital, Italy; Department of Neurology (J.M.C., A.E.G., P.N.), Amsterdam University Medical Centers (AUMC), Location AMC, University of Amsterdam, the Netherlands; Neurology Clinic Belgrade (V.P., D.R.J.), Clinical Centre of Serbia; Medical Faculty (D.R.J.), University of Belgrade, Serbia; Department of Neurology (Y.B., C.B.), University Hospital of Dijon, University of Burgundy; Department of Neurology (G.T., P.S.), Sainte-Anne Hospital, Paris, France; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia; Stroke Unit (M.M.), ASST Spedali Civili, Brescia, Italy; Department of Neurology (D.L., S.G.), University Hospital of Lille, France; Department of Neurology (M.J.S., G.K.), St. Gallen Cantonal Hospital, Switzerland; Department of Neurology (T.T.), Sahlgrenska University Hospital; Department of Clinical Neurosciences (T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; and Neurorehabilitation Unit (S.T.E.), University Center for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital, University of Basel, Switzerland.
出版信息
Neurology. 2020 Jul 28;95(4):e362-e373. doi: 10.1212/WNL.0000000000009951. Epub 2020 Jun 29.
OBJECTIVE
To evaluate whether pretreatment with metformin (MET) is associated with less stroke severity and better outcome after IV thrombolysis (IVT), we analyzed a cohort of 1,919 patients with stroke with type 2 diabetes mellitus in a multicenter exploratory analysis.
METHODS
Data from patients with diabetes and ischemic stroke treated with IVT were collected within the European Thrombolysis in Ischemic Stroke Patients (TRISP) collaboration. We applied propensity score matching (PSM) to obtain balanced baseline characteristics of patients treated with and without MET.
RESULTS
Of 1,919 patients with stroke with type 2 diabetes who underwent IVT, 757 (39%) had received MET before stroke (MET+), whereas 1,162 (61%) had not (MET-). MET+ patients were younger with a male preponderance. Hypercholesterolemia and pretreatment with statins, antiplatelets, or antihypertensives were more common in the MET+ group. After PSM, the 2 groups were well balanced with respect to demographic and clinical aspects. Stroke severity on admission (NIH Stroke Scale 10.0 ± 6.7 vs 11.3 ± 6.5), 3-month degree of independence on modified Rankin Scale (2 [interquartile range (IQR) 1.0-4.0] vs 3 [IQR 1.0-4.0]), as well as mortality (12.5% vs 18%) were significantly lower in the MET+ group. The frequency of symptomatic intracerebral hemorrhages did not differ between groups. HbA1c levels were well-balanced between the groups.
CONCLUSIONS
Patients with stroke and diabetes on treatment with MET receiving IVT had less severe strokes on admission and a better functional outcome at 3 months. This suggests a protective effect of MET resulting in less severe strokes as well as beneficial thrombolysis outcome.
目的
通过一项多中心探索性分析，评估二甲双胍（MET）预处理是否与静脉溶栓（IVT）后卒中严重程度降低和结局改善相关，我们对 1919 例伴有 2 型糖尿病的卒中患者进行了分析。
方法
从接受 IVT 治疗的糖尿病和缺血性卒中患者的欧洲溶栓治疗缺血性卒中患者（TRISP）合作中收集数据。我们应用倾向评分匹配（PSM）获得接受和未接受 MET 治疗的患者基线特征的平衡。
结果
在接受 IVT 的 1919 例伴有 2 型糖尿病的卒中患者中，757 例（39%）在卒中前接受过 MET（MET+），而 1162 例（61%）未接受（MET-）。MET+患者年龄较小，男性居多。高脂血症和他汀类药物、抗血小板药物或降压药物的预处理在 MET+组中更为常见。经过 PSM 后，2 组在人口统计学和临床方面得到了很好的平衡。入院时的卒中严重程度（NIH 卒中量表 10.0±6.7 比 11.3±6.5）、3 个月时改良 Rankin 量表的独立性程度（2[四分位间距（IQR）1.0-4.0]比 3[IQR 1.0-4.0]）以及死亡率（12.5%比 18%）在 MET+组中显著降低。两组之间症状性颅内出血的发生率没有差异。HbA1c 水平在两组之间得到很好的平衡。
结论
接受 IVT 治疗的伴有糖尿病的 MET 治疗患者入院时卒中严重程度较轻，3 个月时功能结局较好。这表明 MET 的保护作用可导致卒中严重程度减轻以及溶栓结局改善。
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