Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Diabetes Care. 2021 Sep;44(9):2140-2148. doi: 10.2337/dc21-0271. Epub 2021 Jul 2.
To evaluate whether prestroke glucose control is associated with functional outcomes in patients with acute large vessel occlusive stroke and diabetes who underwent intra-arterial thrombectomy (IAT).
From the Clinical Research Center for Stroke-Korea registry, we included patients with emergent large vessel occlusive stroke with diabetes who underwent IAT between January 2009 and March 2020. The association between the HbA level at admission and functional outcomes (modified Rankin Scale at 3 months after the index stroke) was assessed.
A total of 1,351 patients were analyzed. Early neurological deterioration was more common in patients with higher levels of HbA at admission ( = 0.02 according to HbA quintiles, = 0.003 according to an HbA cutoff value of 7.0%) than in those with lower HbA levels. Higher HbA levels at admission were significantly associated with decreased odds of favorable functional outcomes at a threshold of 7.0-7.1%. The association was consistently observed in subgroups divided according to age, sex, stroke subtype, occlusion site, degree of recanalization, thrombolysis modalities, time from symptom onset to groin puncture, and treatment period.
Prestroke glucose control with a target HbA of ≤7.0% may be beneficial for neurological recovery in patients with diabetes undergoing IAT for large vessel occlusive stroke, regardless of stroke subtype, bridging intravenous thrombolysis, occlusion site, degree of recanalization, and treatment period.
评估急性大血管闭塞性卒中合并糖尿病患者行动脉内取栓术（IAT）前的血糖控制情况与功能结局的相关性。
我们纳入了 2009 年 1 月至 2020 年 3 月期间因急性大血管闭塞性卒中且合并糖尿病而行 IAT 的患者，来自韩国卒中临床研究中心注册研究。评估入院时的糖化血红蛋白（HbA）水平与功能结局（指数卒中后 3 个月时的改良 Rankin 量表评分）之间的相关性。
共分析了 1351 例患者。入院时 HbA 水平较高的患者更易发生早期神经功能恶化（根据 HbA 五分位值， = 0.02；根据 HbA 截断值 7.0%， = 0.003）。入院时 HbA 水平较高与达到 7.0-7.1%的有利功能结局的可能性降低显著相关。根据年龄、性别、卒中亚型、闭塞部位、再通程度、溶栓方式、从症状发作到腹股沟穿刺的时间和治疗时间等亚组进行分层后，该相关性仍存在。
对于接受 IAT 治疗的大血管闭塞性卒中合并糖尿病患者，目标 HbA 控制在 7.0%以下可能有益于神经功能恢复，无论卒中亚型、桥接静脉溶栓、闭塞部位、再通程度和治疗时间如何。
