Liu X, Nie X M, Pu Y H, Yan H Y, Pan Y S, Liu L P
Departmentof Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
National Clinical Research Center for Neurological Diseases, Beijing 100070, China.
Zhonghua Yi Xue Za Zhi. 2022 Jul 19;102(27):2096-2102. doi: 10.3760/cma.j.cn112137-20211214-02788.
To investigate the correlation between stress hyperglycemia ratio (SHR) and outcomes in patients with acute ischemic stroke treated with endovascular treatment. In a multicenter registration study for RESCUE-RE (a registration study for critical care of acute ischemic stroke after recanalization), eligible patients with large vessel occlusion stroke within 24 hours after onset who received endovascular treatment between July 2018 and May 2019 were enrolled. SHR was calculated as the fasting glucose concentration divided by the estimated average glucose concentration and then categorized into four groups according to the quartiles (group , group , group and group ). The primary outcome was poor neurological outcomeat day 90 fromstroke onset [defined as modified Rankin scale (mRS) of 3-6]. Secondary outcomes included early neurological deterioration (END), death within 3 months after stroke onset, and symptomatic intracranial hemorrhage.Multivariable logistic and Cox regression modelswere used to assess the correlation between quartiles of SHR and prognosis in patients with endovascular treatment. A total of 592 patients were enrolled in the study, with a mean age of (63±12) years, and 68.07% were male.The median National Institute of Health stroke scale(NIHSS) score on admission was15(11, 20), and the median SHR was 1.23 (1.07, 1.47), with SHR<1.07 in group , 1.07≤SHR<1.23 in group , 1.23≤SHR<1.47 in group and SHR≥1.47 in group , respectively. The rate of complete recanalization was lower in group than that of group (70.27% vs 83.67%, =0.026). After fully adjusted for potential covariates, the risk of poor neurological outcome at day 90 from stroke onset in group was 2.38 folds that of group (adjusted = 2.38, 95%: 1.57-3.57,=0.003). The risk of death within 3 months of patients in group was 1.80 times that of the patients in group , but the difference was not statistically significant(adjusted =1.80, 95%: 0.90-3.62, =0.098). Higher SHR was correlated with poor neurological outcome at 3 months in large artery occlusion related acute ischemic stroke patients receiving endovascular therapy.
探讨血管内治疗的急性缺血性脑卒中患者应激性高血糖比值（SHR）与预后的相关性。在一项针对RESCUE-RE（急性缺血性脑卒中再通后重症监护的注册研究）的多中心注册研究中，纳入了2018年7月至2019年5月期间发病24小时内接受血管内治疗的符合条件的大血管闭塞性脑卒中患者。SHR计算为空腹血糖浓度除以估计的平均血糖浓度，然后根据四分位数分为四组（组1、组2、组3和组4）。主要结局为卒中发病后90天神经功能预后不良[定义为改良Rankin量表（mRS）评分为3 - 6分]。次要结局包括早期神经功能恶化（END）、卒中发病后3个月内死亡以及症状性颅内出血。采用多变量逻辑回归和Cox回归模型评估血管内治疗患者SHR四分位数与预后的相关性。共有592例患者纳入研究，平均年龄为（63±12）岁，男性占68.07%。入院时美国国立卫生研究院卒中量表（NIHSS）评分中位数为15（11，20），SHR中位数为1.23（1.07，1.47），组1中SHR<1.07，组2中1.07≤SHR<1.23，组3中1.23≤SHR<1.47，组4中SHR≥1.47。组1的完全再通率低于组2（70.27%对83.67%，P = 0.026）。在对潜在协变量进行充分调整后，组4卒中发病后90天神经功能预后不良的风险是组1的2.38倍（调整后比值比 = 2.38，95%置信区间：1.57 - 3.57，P = 0.003）。组4患者卒中后3个月内死亡风险是组1患者的1.80倍，但差异无统计学意义（调整后比值比 = 1.80，95%置信区间：0.90 - 3.62，P = 0.098）。较高的SHR与接受血管内治疗的大动脉闭塞相关急性缺血性脑卒中患者3个月时神经功能预后不良相关。
