Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea.
Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
Cerebrovasc Dis. 2021;50(1):26-33. doi: 10.1159/000511938. Epub 2020 Dec 1.
Whether glycemic variability prior to stroke increases the risk of stroke outcomes in prediabetic patients presenting with acute ischemic stroke is still unclear. We evaluated whether pre-stroke glycemic variability, estimated by glycated albumin (GA), increased early neurological deterioration (END) and functional outcomes in prediabetic patients with acute ischemic stroke.
A total of 215 acute ischemic stroke patients with prediabetes were evaluated. The primary outcome was END, defined as an incremental increase in the National Institutes of Health Stroke Scale score by ≥1 point in motor power or ≥2 points in the total score within the 7 days after admission. The secondary outcome was poor functional status defined by a modified Rankin Scale at 3 months. Higher GA (≥16.0%) was determined to reflect glycemic fluctuation prior to ischemic stroke.
Of the 215 prediabetic patients, 77 (35.8%) were in the higher GA group. In prediabetic patients, END occurrence and poor functional status were higher in the higher GA group than in the lower GA group. The multivariate analysis showed that a higher GA was associated with an increased risk of END occurrence and poor functional outcomes at 3 months (adjusted odds ratio [95% confidence interval], 4.58 [1.64-12.81], p = 0.004 and 2.50 [1.19-5.25], p = 0.02, respectively).
Pre-stroke glycemic variability estimated by GA was associated with END occurrence and poor functional outcome after ischemic stroke in patients with prediabetes.
在出现急性缺血性脑卒中的糖尿病前期患者中，脑卒中前的血糖变异性是否会增加脑卒中结局的风险尚不清楚。我们评估了糖尿病前期急性缺血性脑卒中患者中，由糖化白蛋白（GA）估计的脑卒中前血糖变异性是否会增加早期神经功能恶化（END）和功能结局。
共评估了 215 例糖尿病前期急性缺血性脑卒中患者。主要结局是 END，定义为入院后 7 天内运动力量增加≥1 分或总分增加≥2 分的 NIHSS 评分的增量增加。次要结局是 3 个月时改良 Rankin 量表定义的不良功能状态。较高的 GA（≥16.0%）被认为反映了缺血性脑卒中前的血糖波动。
在 215 例糖尿病前期患者中，77 例（35.8%）处于较高 GA 组。在糖尿病前期患者中，较高 GA 组的 END 发生率和不良功能状态均高于较低 GA 组。多变量分析显示，较高的 GA 与 END 发生率和 3 个月时的不良功能结局相关（调整后的优势比[95%置信区间]，4.58[1.64-12.81]，p=0.004 和 2.50[1.19-5.25]，p=0.02）。
由 GA 估计的脑卒中前血糖变异性与糖尿病前期患者缺血性脑卒中后 END 发生率和不良功能结局相关。
