Han Lin, Hou Zhangyan, Ma Mingwei, Ding Dongxue, Wang Dapeng, Fang Qi
Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Front Aging Neurosci. 2023 Jan 12;14:1073267. doi: 10.3389/fnagi.2022.1073267. eCollection 2022.
In patients with acute mild ischemic stroke treated with intravenous thrombolysis, the relationship between chronic hyperglycemic status and their early neurological deterioration (END) and clinical outcomes is unclear. We attempted to analyze the relationship between glycated hemoglobin (HbA1c) levels and END and 90-day functional outcomes.
The research comprised 267 patients with acute mild ischemic stroke. The incidence of END and functional outcomes at 90 days were evaluated between subgroups. END was defined in this study as a rise of at least 1 point in the National Institutes of Health Stroke Scale (NIHSS) score within 72 h of admission, with an excellent outcome of a modified Rankin Scale (mRS) score of 0-1 at 90 days following stroke beginning. The association between HbA1c and END, and clinical outcomes in patients with mild stroke, was assessed by logistic regression after adjusting for confounding factors. In addition, we used receiver operating characteristic (ROC) curves to predict the predictive value of HbA1c for the incidence of END.
There were 38 patients who suffered END and 105 patients who had disabled functional outcomes at 90 days. In multivariate analysis, elevated HbA1c levels were associated with END (adjusted OR = 1.476; 95% CI: 1.129-1.928; = 0.004). With HbA1c greater than 7.75%, the ROC curve predicted a higher risk of END. However, they were not associated with patients' functional outcomes at 90 days.
HbA1c levels were an independent predictor of END in patients with mild stroke, while there was no effect on functional outcomes at 90 days. The impact of HbA1c on functional prognosis may be a contributing factor rather than a direct factor.
在接受静脉溶栓治疗的急性轻度缺血性脑卒中患者中，慢性高血糖状态与其早期神经功能恶化（END）及临床结局之间的关系尚不清楚。我们试图分析糖化血红蛋白（HbA1c）水平与END及90天功能结局之间的关系。
该研究纳入了267例急性轻度缺血性脑卒中患者。在各亚组之间评估END的发生率及90天时的功能结局。本研究中END的定义为入院72小时内美国国立卫生研究院卒中量表（NIHSS）评分至少升高1分，卒中开始后90天时改良Rankin量表（mRS）评分为0 - 1分为良好结局。在调整混杂因素后，通过逻辑回归评估HbA1c与轻度卒中患者END及临床结局之间的关联。此外，我们使用受试者工作特征（ROC）曲线来预测HbA1c对END发生率的预测价值。
有38例患者发生END，105例患者在90天时功能结局为残疾。在多变量分析中，HbA1c水平升高与END相关（校正比值比=1.476；95%置信区间：1.129 - 1.928；P = 0.004）。当HbA1c大于7.75%时，ROC曲线预测END风险更高。然而，它们与患者90天时的功能结局无关。
HbA1c水平是轻度卒中患者END的独立预测因素，而对90天时的功能结局无影响。HbA1c对功能预后的影响可能是一个促成因素而非直接因素。
