Yue Feixue, Wang Zhongxiu, Pu Jie, Zhang Min, Liu Yong, Han Hongxing, Liu Wenhua, Wang Xianjun, Li Rongzong, Xue Dongzhang, Cao Jiaming, Yan Zhizhong, Niu Guozhong, Zhang Hao, Guan Haitao, Zeng Hongliang, You Feng, Yang Qian, Zi Wenjie, Zhang Yi, Shao Zetao, Liu Jincheng, Sun Jun, Wang Shouchun
Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China.
Department of Neurology, Hubei Province People's Hospital, Wuhan, China.
Ther Adv Neurol Disord. 2020 Dec 28;13:1756286420981354. doi: 10.1177/1756286420981354. eCollection 2020.
Recently, several clinical trials have shown that increased glycated hemoglobin (HbA1c) level is correlated with poor clinical outcomes in ischemic stroke patients after thrombolysis and possibly after mechanical thrombectomy. However, the effect of HbA1c on posterior circulation large vessel occlusion (PCLVO) patients treated with endovascular thrombectomy (EVT) remains unclear. This multicenter study assessed the association between the HbA1c levels and clinical outcomes in patients with PCLVO after EVT.
We studied 385 PCLVO ischemic stroke patients included in the EVT for acute basilar artery occlusion study (BASILAR). Patients were divided into a high HbA1c level group (HbA1c >6.5%) and a low HbA1c level group (HbA1c ⩽6.5%). The efficacy outcome was a 90-day favorable functional outcome (modified Rankin Scale 0-3). The safety outcomes included symptomatic intracerebral hemorrhage and mortality at 90 days after EVT.
The frequency of a favorable outcome in patients with an HbA1c ⩽6.5% was significantly higher than that in the HbA1c >6.5% group (41.2% 26.2%, = 0.001). In multivariate analysis with adjusted confounders, high HbA1c levels and favorable outcomes were significantly negatively correlated. There was also a significant association between high HbA1c levels and mortality after 3 months. The negative effects of high HbA1c levels on functional status after 3 months were exacerbated in patients aged ⩾65 years.
Our multicenter study suggests that a higher serum HbA1c level (HbA1c >6.5%) is an independent predictor of a 90-day poor outcome and mortality in patients with PCLVO after EVT, particularly in those aged ⩾65 years. ChiCTR1800014759.
最近，多项临床试验表明，糖化血红蛋白（HbA1c）水平升高与缺血性中风患者溶栓后以及可能在机械取栓后的不良临床结局相关。然而，HbA1c对接受血管内取栓术（EVT）治疗的后循环大血管闭塞（PCLVO）患者的影响仍不清楚。这项多中心研究评估了EVT后PCLVO患者HbA1c水平与临床结局之间的关联。
我们研究了纳入急性基底动脉闭塞血管内取栓术（BASILAR）研究的385例PCLVO缺血性中风患者。患者被分为高HbA1c水平组（HbA1c>6.5%）和低HbA1c水平组（HbA1c≤6.5%）。疗效结局为90天良好功能结局（改良Rankin量表0 - 3分）。安全性结局包括症状性脑出血和EVT后90天死亡率。
HbA1c≤6.5%患者的良好结局频率显著高于HbA1c>6.5%组（41.2%对26.2%，P = 0.001）。在调整混杂因素的多变量分析中，高HbA1c水平与良好结局显著负相关。高HbA1c水平与3个月后死亡率之间也存在显著关联。在年龄≥65岁的患者中，高HbA1c水平对3个月后功能状态的负面影响加剧。
我们的多中心研究表明，较高的血清HbA1c水平（HbA1c>6.5%）是EVT后PCLVO患者90天不良结局和死亡率的独立预测因素，尤其是在年龄≥65岁的患者中。中国临床试验注册中心注册号：ChiCTR1800014759
