Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea.
Department of Radiology, Dongguk University Ilsan Hospital, Goyang, South Korea.
Front Endocrinol (Lausanne). 2022 Aug 16;13:956367. doi: 10.3389/fendo.2022.956367. eCollection 2022.
Hypoglycemic encephalopathy (HE) can cause long-lasting mental changes, disability, and even death. We aimed to investigate prognostic factors for HE and to determine when the treatment of HE becomes futile.
We retrospectively evaluated the data of patients admitted for prolonged HE at Dongguk University Ilsan Hospital between December 2005 and July 2021. We assessed the Glasgow Outcome Scale (GOS) to assess functional outcome.
Forty-four patients were enrolled in the study. Thirty-two of these showed the improvement on GOS after treatment. Patients with improved consciousness had a shorter duration of hypoglycemia (1.6±1.4 vs. 7.8±15.0 hours, = 0.04) and a lower incidence of brain lesions than those without improvements in consciousness (76.0% vs. 25.0%, < 0.01). Patients whose lesions were detected in initial MRIs were 1.3 times less likely to recover consciousness after HE (odds ratios, 1.28; 95% CI, 1.09-1.52; < 0.01). None of the patients recovered consciousness after 320 h. Maximum time spent to recover was 194 in patients without brain lesions and 319 in those with lesions.
Hypoglycemic brain injury detected in initial MRIs predicted poorer HE prognosis. Nevertheless, treatment should be provided for at least for 14 days after admission.
低血糖性脑病（HE）可导致持久的精神改变、残疾，甚至死亡。本研究旨在探讨 HE 的预后因素，并确定何时治疗 HE 变得无效。
我们回顾性评估了 2005 年 12 月至 2021 年 7 月期间在东国大学 Ilsan 医院因持续性 HE 入院的患者数据。我们使用 Glasgow 预后量表（GOS）评估患者的功能预后。
共有 44 例患者入组本研究。其中 32 例患者在治疗后意识状态改善。与意识状态未改善的患者相比，意识状态改善的患者低血糖持续时间更短（1.6±1.4 小时 vs. 7.8±15.0 小时， = 0.04），且脑部病变发生率更低（76.0% vs. 25.0%， < 0.01）。在初始 MRI 上发现病变的患者，其 HE 后恢复意识的可能性降低 1.3 倍（比值比，1.28；95%可信区间，1.09-1.52； < 0.01）。在 320 小时后，没有患者恢复意识。无脑部病变患者的最长恢复时间为 194 小时，而有病变患者的最长恢复时间为 319 小时。
在初始 MRI 上发现的低血糖性脑损伤预示着 HE 预后更差。然而，即使患者在治疗 14 天后仍未恢复意识，也应继续给予治疗。
