应激性高血糖比值对急性缺血性脑卒中血管内治疗后早期神经功能恶化和功能结局的影响。

Impacts of stress hyperglycemia ratio on early neurological deterioration and functional outcome after endovascular treatment in patients with acute ischemic stroke.

机构信息

Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China.

Department of Neurology, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.

出版信息

Front Endocrinol (Lausanne). 2023 Jan 26;14:1094353. doi: 10.3389/fendo.2023.1094353. eCollection 2023.

DOI:10.3389/fendo.2023.1094353

PMID:36777360

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9910688/

Abstract

BACKGROUND AND PURPOSE

Hyperglycemia has been associated with unfavorable outcome of acute ischemic stroke, but this association has not been verified in patients with endovascular thrombectomy treatment. This study aimed to assess the impact of stress hyperglycemia ratio on early neurological deterioration and favorable outcome after thrombectomy in patients with acute ischemic stroke.

METHODS

Stroke patients with endovascular thrombectomy in two comprehensive centers were enrolled. Early neurological deterioration was defined as ≥4 points increase of National Institutes of Health Stroke Scale (NIHSS) at 24 hours after endovascular procedure. Favorable outcome was defined as modified Rankin Scale (mRS) score of 0-2 at 90 days of stroke onset. Multivariate regression analysis was used to identify the predictors for early neurological deterioration and favorable outcome.

RESULTS

Among the 559 enrolled, 74 (13.2%) patients developed early neurological deterioration. The predictors for early neurological deterioration were high stress hyperglycemia ratio at baseline (OR =5.77; 95% CI, 1.878-17.742; =0.002), symptomatic intracranial hemorrhage (OR =4.90; 95% CI, 2.439-9.835; 0.001) and high NIHSS score after 24 hours (OR =1.11; 95% CI, 1.071-1.151; 0.001). The predictors for favorable outcome were stress hyperglycemia ratio (OR =0.196, 95% CI, 0.077-0.502; =0.001), age (OR =0.942, 95% CI, 0.909-0.977; =0.001), NIHSS score 24 hours after onset (OR =0.757, 95% CI =0.693-0.827; P <0.001), groin puncture to recanalization time (OR =0.987, 95% CI, 0.975-0.998; =0.025), poor collateral status before treatment (ASITN/SIR grade 0-3, OR =62.017, 95% CI, 25.920-148.382; 0.001), successful recanalization (mTICI 2b or 3, OR =7.415, 95% CI, 1.942-28.313; =0.001).

CONCLUSION

High stress hyperglycemia ratio may be related to early neurological deterioration and decreased likelihood of favourable outcomes after endovascular thrombectomy in patients with acute ischemic stroke.

摘要

背景与目的

高血糖与急性缺血性卒中不良结局相关，但该相关性尚未在血管内取栓治疗患者中得到验证。本研究旨在评估应激性高血糖比值对急性缺血性卒中患者血管内取栓后早期神经恶化和良好预后的影响。

方法

在两家综合中心招募接受血管内取栓的卒中患者。早期神经恶化定义为血管内手术后 24 小时 NIHSS 评分增加≥4 分。良好预后定义为发病 90 天时 mRS 评分 0-2 分。采用多变量回归分析识别早期神经恶化和良好预后的预测因素。

结果

在纳入的 559 例患者中，74 例（13.2%）患者发生早期神经恶化。早期神经恶化的预测因素包括基线时高应激性高血糖比值（OR=5.77；95%CI，1.878-17.742；P=0.002）、症状性颅内出血（OR=4.90；95%CI，2.439-9.835；P=0.001）和 24 小时后 NIHSS 评分升高（OR=1.11；95%CI，1.071-1.151；P=0.001）。良好预后的预测因素包括应激性高血糖比值（OR=0.196，95%CI，0.077-0.502；P=0.001）、年龄（OR=0.942，95%CI，0.909-0.977；P=0.001）、发病后 24 小时 NIHSS 评分（OR=0.757，95%CI=0.693-0.827；P<0.001）、股动脉穿刺至再通时间（OR=0.987，95%CI，0.975-0.998；P=0.025）、治疗前较差的侧支循环状态（ASITN/SIR 分级 0-3，OR=62.017，95%CI，25.920-148.382；P=0.001）和成功再通（mTICI 2b 或 3，OR=7.415，95%CI，1.942-28.313；P=0.001）。