高血糖对自发性脑出血患者预后的预测价值
Predictive value of hyperglycemia on prognosis in spontaneous intracerebral hemorrhage patients.
作者信息
Gong Yue, Wang Yifei, Chen Du, Teng Yue, Xu Feng, Yang Peng
机构信息
First Affiliated Hospital of Soochow University, China.
出版信息
Heliyon. 2023 Mar 8;9(3):e14290. doi: 10.1016/j.heliyon.2023.e14290. eCollection 2023 Mar.
BACKGROUND
Spontaneous intracerebral hemorrhage (ICH) is the second most common cause of stroke and accounts for approximately 15-20% of all new stroke cases. Hematoma expansion is a potentially important therapeutic target that is amenable to treatment and independently predict outcome. Hyperglycemia is frequent in ICH patients, and affects cerebrovascular function, increasing the risk of cerebral vascular rupture. We recruited 170 ICH patients to explore the high risk factors of mortality and the association between hyperglycemia and early hematoma expansion.
METHODS
A retrospective analysis of 170 patients with ICH who were grouped by survival and blood glucose level, death group (35 cases) and survival group (135 cases); 77 cases in the hyperglycemic group and 93 cases in the normoglycemic group. Recorded parameters, such as age, gender, past medical history, blood glucose, serum calcium, hematoma volume, and hematoma expansion. Group comparison used -test, rank sum test and Fisher exact test. After these, logistic regression analysis and receiver operating characteristic (ROC) curves were performed.
RESULTS
Among 170 ICH subjects(130 males and 40 females)，35 died and 77 exhibited hyperglycaemia. Compared with the survival group, the death group presented with higher Original Intracerebral Hemorrhage Scale (OICH) score, greater blood glucose, larger hemorrhage volume and lower Glasgow Coma Scale (GCS) score. The occurrence of hematoma expansion and massive hemorrhage volume in the hyperglycemic group were higher than in the normoglycemic group(P < 0.05). After adjustment for confounders variables, multivariate logistic analysis showed that blood glucose was an independent predictor of hematoma expansion (adjusted odd ratio:8.04, 95%CI:3.89-16.63, P < 0.01). Fasting blood glucose had better predictive value for hematoma expansion (AUC:0.95, 95%CI:0.92-0.99, P < 0.01).
CONCLUSION
Hyperglycemia is associated with higher mortality risk and could be a potential marker in the prediction of hematoma expansion.
背景
自发性脑出血（ICH）是中风的第二大常见病因，约占所有新发中风病例的15 - 20%。血肿扩大是一个潜在的重要治疗靶点，适合进行治疗且能独立预测预后。脑出血患者中高血糖很常见，它会影响脑血管功能，增加脑血管破裂的风险。我们招募了170例脑出血患者，以探讨死亡的高危因素以及高血糖与早期血肿扩大之间的关联。
方法
对170例脑出血患者进行回顾性分析，根据生存情况和血糖水平分组，死亡组（35例）和生存组（135例）；高血糖组77例，正常血糖组93例。记录年龄、性别、既往病史、血糖、血清钙、血肿体积和血肿扩大等参数。组间比较采用t检验、秩和检验和Fisher确切检验。在此之后，进行逻辑回归分析和受试者工作特征（ROC）曲线分析。
结果
在170例脑出血患者（130例男性和40例女性）中，35例死亡，77例出现高血糖。与生存组相比，死亡组的原始脑出血量表（OICH）评分更高、血糖更高、出血量更大且格拉斯哥昏迷量表（GCS）评分更低。高血糖组血肿扩大和大量出血的发生率高于正常血糖组（P < 0.05）。在对混杂变量进行调整后，多因素逻辑分析表明血糖是血肿扩大的独立预测因素（调整后的比值比：8.04，95%可信区间：3.89 - 16.63，P < 0.01）。空腹血糖对血肿扩大具有更好的预测价值（曲线下面积：0.95，95%可信区间：0.92 - 0.99，P < 0.01）。
结论
高血糖与更高的死亡风险相关，可能是预测血肿扩大的一个潜在标志物。
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