Ouyang Qingrong, Xu Lei, Zhang Yunwei, Huang Luwen, Du Yang, Yu Ming
Department of Neurology, Suining Central Hospital, Suining 629000, China.
Department of Neurology, Suining Central Hospital, Suining 629000, China.
Exp Gerontol. 2024 Apr;188:112395. doi: 10.1016/j.exger.2024.112395. Epub 2024 Mar 6.
Chronic Post-Stroke Fatigue (PSF) is a common and persistent complications among ischemic stroke survivors. The serum glycated hemoglobin (HbA1c) level, as it is known has emerged as a critical risk factor for Acute Ischemic Stroke (AIS) and post-stroke cognitive and emotional impairment. However, no studies have been conducted on the link between HbA1c and PSF. Therefore, this study aims to estimate the relationship between HbA1c and PSF in the chronic phase.
A longitudinal study was conducted on 559 patients diagnosed with their first AIS episode and admitted to Suining Central Hospital within three days after onset. All patients were examined for serum HbA1c, blood glucose levels and routine blood biochemical indicators at admission. The Fatigue Severity Scale (FSS) was employed to assess fatigue symptoms at six months post-stroke. Multivariate logistic regression and smooth curve fitting were used to analyze the relationship between admission HbA1c, blood glucose levels, discharge blood glucose and PSF, and the predictive value of HbA1c on PSF was assessed using a segmented linear regression model.
189(33.8 %)of the 559 patients included in the study, reported PSF at six-month follow-up. Compared with the non-PSF group, the PSF group displayed significantly higher levels of HbA1c (7.8 ± 3.0 vs 6.5 ± 2.0 %, P < 0.001), admission blood glucose (7.8 ± 3.8 vs 7.1 ± 3.5 mmol/L, P = 0.041), and discharge blood glucose (6.3 ± 1.6 vs 5.8 ± 1.2 mmol/L, P < 0.001). The dose-response relationship among admission HbA1c, blood glucose, discharge blood glucose and PSF showed that HbA1c level is positively and non-linearly related to the risk of PSF. A linear positive correlation is noted between PSF and discharge blood glucose levels, while no significant correlation was observed for the blood glucose levels upon admission.
Higher HbA1c levels at admission were independently associated with the risk of chronic PSF, the correlation between blood glucose and PSF showed significant variability, HbA1c may serve as a more stable risk factor in predicting the occurrence of chronic PSF and long-term active glycemic management may have a favorable impact on chronic PSF after AIS.
慢性卒中后疲劳（PSF）是缺血性卒中幸存者中常见且持续存在的并发症。众所周知，血清糖化血红蛋白（HbA1c）水平已成为急性缺血性卒中（AIS）以及卒中后认知和情感障碍的关键危险因素。然而，尚未有关于HbA1c与PSF之间关联的研究。因此，本研究旨在评估慢性期HbA1c与PSF之间的关系。
对559例首次诊断为AIS发作且在发病后三天内入住遂宁市中心医院的患者进行了一项纵向研究。所有患者在入院时均接受血清HbA1c、血糖水平及常规血液生化指标检查。采用疲劳严重程度量表（FSS）评估卒中后六个月的疲劳症状。使用多因素逻辑回归和平滑曲线拟合分析入院时HbA1c、血糖水平、出院时血糖与PSF之间的关系，并使用分段线性回归模型评估HbA1c对PSF的预测价值。
研究纳入的559例患者中，189例（33.8%）在六个月随访时报告有PSF。与非PSF组相比，PSF组的HbA1c水平（7.8±3.0 vs 6.5±2.0%，P<0.001）、入院血糖（7.8±3.8 vs 7.1±3.5 mmol/L，P = 0.041）和出院血糖（6.3±1.6 vs 5.8±1.2 mmol/L，P<0.001）显著更高。入院时HbA1c、血糖、出院时血糖与PSF之间的剂量反应关系表明，HbA1c水平与PSF风险呈正相关且为非线性关系。PSF与出院时血糖水平呈线性正相关，而入院时血糖水平未观察到显著相关性。
入院时较高的HbA1c水平与慢性PSF风险独立相关，血糖与PSF之间的相关性存在显著差异，HbA1c可能是预测慢性PSF发生更稳定的危险因素，长期积极的血糖管理可能对AIS后的慢性PSF产生有利影响。
