Akhtar Naveed, Singh Rajvir, Kamran Saadat, Babu Blessy, Sivasankaran Shobana, Joseph Sujatha, Morgan Deborah, Shuaib Ashfaq
The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
Cardiology Research Center, Hamad Medical Corporation, Doha, Qatar.
Front Neurol. 2022 Apr 26;13:849607. doi: 10.3389/fneur.2022.849607. eCollection 2022.
To evaluate if in patients with known diabetes, pretreatment metformin will lead to less severe stroke, better outcome, and lower mortality following acute stroke.
The Qatar stroke database was interrogated for stroke severity and outcome in patients with ischemic stroke. Outcome was compared in nondiabetic vs. diabetic patients and in diabetic patients on metformin vs. other hypoglycemic agents. The National Institute of Health Stroke Scale was used to measure stroke severity and 90-day modified Rankin scale (mRS) score to determine outcome following acute stroke.
In total, 4,897 acute stroke patients [nondiabetic: 2,740 (56%) and diabetic: 2,157 (44%)] were evaluated. There were no significant differences in age, risk factors, stroke severity and type, or thrombolysis between the two groups. At 90 days, mRS (shift analysis) showed significantly poor outcome in diabetic patients ( < 0.001) but no differences in mortality. In the diabetic group, 1,132 patients were on metformin and 1,025 on other hypoglycemic agents. mRS shift analysis showed a significantly better outcome in metformin-treated patients ( < 0.001) and lower mortality (8.1 vs. 4.6% < 0.001). Multivariate negative binomial analyses showed that the presence of diabetes negatively affected the outcome (90-day mRS) by factor 0.17 (incidence risk ratio, IRR, 1.17; CI [1.08-1.26]; < 0.001) when all independent variables were held constant. In diabetic patients, pre-stroke treatment with metformin improved the outcome (90-day mRS) by factor 0.14 (IRR 0.86 [CI 0.75-0.97] = 0.006).
Similar to previous reports, our study shows that diabetes adversely affects stroke outcome. The use of prior metformin is associated with better outcome in patients with ischemic stroke and results in lower mortality. The positive effects of metformin require further research to better understand its mechanism.
评估在已知患有糖尿病的患者中，急性卒中前使用二甲双胍是否会导致卒中症状较轻、预后更好以及死亡率更低。
查询卡塔尔卒中数据库，了解缺血性卒中患者的卒中严重程度和预后情况。比较非糖尿病患者与糖尿病患者，以及使用二甲双胍的糖尿病患者与使用其他降糖药物的糖尿病患者的预后。采用美国国立卫生研究院卒中量表来衡量卒中严重程度，并用90天改良Rankin量表（mRS）评分来确定急性卒中后的预后。
总共评估了4897例急性卒中患者[非糖尿病患者：2740例（56%），糖尿病患者：2157例（44%）]。两组在年龄、危险因素、卒中严重程度和类型或溶栓治疗方面无显著差异。在90天时，mRS（移位分析）显示糖尿病患者的预后明显较差（<0.001），但死亡率无差异。在糖尿病组中，1132例患者使用二甲双胍，1025例患者使用其他降糖药物。mRS移位分析显示，二甲双胍治疗的患者预后明显更好（<0.001），死亡率更低（8.1%对4.6%，<0.001）。多变量负二项式分析表明，当所有自变量保持不变时，糖尿病的存在会使预后（90天mRS）受到0.17倍的负面影响（发病率风险比，IRR，1.17；CI[1.08 - 1.26]；<0.001）。在糖尿病患者中，卒中前使用二甲双胍使预后（90天mRS）改善了0.14倍（IRR 0.86[CI 0.75 - 0.97]，P = 0.006）。
与之前的报告相似，我们的研究表明糖尿病会对卒中预后产生不利影响。既往使用二甲双胍与缺血性卒中患者更好的预后相关，并导致更低的死亡率。二甲双胍的积极作用需要进一步研究以更好地了解其机制。
