Duan Zuowei, Wei Xiu'e, Liu Haiyan, Zhai Yujia, Hu Ting, Xu Jiang, Liu Tengfei, Yang Ming, Rong Liangqun
Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China.
Int J Stroke. 2022 Mar 7:17474930211067352. doi: 10.1177/17474930211067352.
The impact of metabolic syndrome (MetS)/hyperglycemia on the clinical outcomes of ischemic stroke treated with intravenous thrombolysis (IVT) remains controversial. This study aimed to determine the risks conferred by MetS and hyperglycemia to clinical outcomes in acute ischemic stroke patients treated with IVT.
Three hundred forty-three ischemic stroke patients treated with IVT were prospective recruited and stratified into four groups: neither, MetS only, hyperglycemia only, or both. The primary outcome was the 3-month poor functional outcome (PFO) which was defined as a 3-month modified Rankin Score (mRS) score ≧3. The secondary outcome included the hemorrhagic transformation (HT) and symptomatic intracranial hemorrhage (sICH) after IVT.
MetS was recognized in 197 (57.43%) patients. During the first 24 h after IVT, 44 (12.83%) patients had HT, of which 17 had sICH. Three-month PFO was found in 98 (28.57%) patients. After adjustment for potential confounders, MetS (odds ratio (OR) = 3.140, 95% confidence interval (CI) = 1.724-5.718) was independently associated with PFO. However, neither MetS nor its components were associated with 24-h HT or sICH. In the further subgroup analysis, we used the "neither" group as reference and found that the presence of both MetS and hyperglycemia (OR = 3.192, 95% CI = 1.338-7.615) and the presence of hyperglycemia only (OR = 2.097, 95% CI = 1.052-4.179) were significantly related to the 3-month PFO.
MetS is an independent risk factor on 3-month PFO in acute ischemic stroke patients treated with IVT. Compared with "neither," hyperglycemia only or concurrent with MetS was associated with an elevated risk of PFO after receiving IVT.
代谢综合征（MetS）/高血糖对静脉溶栓（IVT）治疗缺血性卒中临床结局的影响仍存在争议。本研究旨在确定MetS和高血糖对接受IVT治疗的急性缺血性卒中患者临床结局的风险。
前瞻性招募343例接受IVT治疗的缺血性卒中患者，并分为四组：均无、仅MetS、仅高血糖或两者皆有。主要结局为3个月时功能预后不良（PFO），定义为3个月改良Rankin量表（mRS）评分≧3。次要结局包括IVT后的出血转化（HT）和症状性颅内出血（sICH）。
197例（57.43%）患者被诊断为MetS。在IVT后的最初24小时内，44例（12.83%）患者发生HT，其中17例发生sICH。98例（28.57%）患者出现3个月PFO。在调整潜在混杂因素后，MetS（比值比（OR）=3.140，95%置信区间（CI）=1.724-5.718）与PFO独立相关。然而，MetS及其组分均与24小时HT或sICH无关。在进一步的亚组分析中，我们以“均无”组作为对照，发现同时存在MetS和高血糖（OR=3.192，95%CI=1.338-7.615）以及仅存在高血糖（OR=2.097，95%CI=1.052-4.179）均与3个月PFO显著相关。
MetS是接受IVT治疗的急性缺血性卒中患者3个月PFO的独立危险因素。与“均无”相比，仅高血糖或与MetS同时存在与接受IVT后PFO风险升高相关。
