超越高血糖：血糖变异性作为急性缺血性卒中后的一个预后因素

Beyond hyperglycemia: glycaemic variability as a prognostic factor after acute ischemic stroke.

作者信息

Gutiérrez-Zúñiga R, Alonso de Leciñana M, Delgado-Mederos R, Gállego-Cullere J, Rodríguez-Yáñez M, Martínez-Zabaleta M, Freijo M, Portilla J C, Gil-Núñez A, Díez Sebastián J, Lisbona A, Díez-Tejedor E, Fuentes B

机构信息

Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España.

Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España.

出版信息

Neurologia (Engl Ed). 2020 Oct 14. doi: 10.1016/j.nrl.2020.06.018.

DOI:10.1016/j.nrl.2020.06.018

PMID:33069448

Abstract

INTRODUCTION

Glycaemic variability (GV) refers to variations in blood glucose levels, and may affect stroke outcomes. This study aims to assess the effect of GV on acute ischaemic stroke progression.

METHODS

We performed an exploratory analysis of the multicentre, prospective, observational GLIAS-II study. Capillary glucose levels were measured every 4 hours during the first 48 hours after stroke, and GV was defined as the standard deviation of the mean glucose values. The primary outcomes were mortality and death or dependency at 3 months. Secondary outcomes were in-hospital complications, stroke recurrence, and the impact of the route of insulin administration on GV.

RESULTS

A total of 213 patients were included. Higher GV values were observed in patients who died (n = 16; 7.8%; 30.9 mg/dL vs 23.3 mg/dL; p = 0.05). In a logistic regression analysis adjusted for age and comorbidity, both GV (OR = 1.03; 95% CI, 1.003-1.06; p = 0.03) and stroke severity (OR = 1.12; 95% CI, 1.04-1.2; p = 0.004) were independently associated with mortality at 3 months. No association was found between GV and the other outcomes. Patients receiving subcutaneous insulin showed higher GV than those treated with intravenous insulin (38.95 mg/dL vs 21.34 mg/dL; p < 0.001).

CONCLUSIONS

High GV values during the first 48 hours after ischaemic stroke were independently associated with mortality. Subcutaneous insulin may be associated with higher VG levels than intravenous administration.

摘要

引言

血糖变异性（GV）是指血糖水平的变化，可能会影响中风的预后。本研究旨在评估GV对急性缺血性中风进展的影响。

方法

我们对多中心、前瞻性、观察性的GLIAS-II研究进行了探索性分析。在中风后的前48小时内，每4小时测量一次毛细血管血糖水平，GV定义为平均血糖值的标准差。主要结局为3个月时的死亡率和死亡或依赖情况。次要结局为住院并发症、中风复发以及胰岛素给药途径对GV的影响。

结果

共纳入213例患者。死亡患者（n = 16；7.8%）的GV值更高（30.9 mg/dL对23.3 mg/dL；p = 0.05）。在对年龄和合并症进行校正的逻辑回归分析中，GV（OR = 1.03；95%CI，1.003 - 1.06；p = 0.03）和中风严重程度（OR = 1.12；95%CI，1.04 - 1.2；p = 0.004）均与3个月时的死亡率独立相关。未发现GV与其他结局之间存在关联。接受皮下胰岛素治疗的患者的GV高于接受静脉胰岛素治疗的患者（38.95 mg/dL对21.34 mg/dL；p < 0.001）。