Wang Liuding, Chen Yifan, Liu Longtao, Jia Min, Zhang Yunfan, Chang Ze, Gong Zhiyi, Lyu Jian, Liang Xiao, Zhang Yunling
Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Departmalet of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Front Endocrinol (Lausanne). 2025 Jul 28;16:1542549. doi: 10.3389/fendo.2025.1542549. eCollection 2025.
Hyperglycemia is acknowledged as a pivotal factor associated with poor prognosis in acute ischemic stroke (AIS). The intricate interplay among hyperglycemia, thrombosis, and inflammation has garnered significant attention. Therefore, we aimed to investigate the association between hemoglobin A1c (HbA1c) and risk of thrombosis, and the role of inflammation, in patients with AIS.
A total of 1,291 patients with AIS were identified from Xiyuan Hospital, China Academy of Chinese Medical Sciences. A propensity score matching was used to address baseline imbalances. AIS patients were divided into a high HbA1c group (n = 419) and a control group (n = 656) based on whether their initial HbA1c levels upon admission were above or below 6.5%. Thrombosis was assessed using coagulation parameters. Inflammation was reflected by markers such as the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI). Chi-square test, independent sample t-test, Mann-Whitney U test, and logistic regression were used for correlation analysis.
In AIS patients, HbA1c levels > 6.5% were significantly associated with abnormal coagulation function and elevated inflammatory response. Among AIS patients with elevated HbA1c, high fibrinogen levels were significantly correlated with increased inflammatory markers such as SII and SIRI. Furthermore, HbA1c > 6.5% was identified as an independent predictor for hypercoagulability in AIS patients ( = 1.74, 95% CI 1.17 - 2.60, = 0.006).
Elevated HbA1c levels were associated with severe hypercoagulability and heightened inflammatory responses following AIS onset. Elevated HbA1c levels may contribute to poorer outcomes, likely due to the thromboinflammation.
高血糖被认为是急性缺血性卒中（AIS）预后不良的关键因素。高血糖、血栓形成和炎症之间复杂的相互作用已引起广泛关注。因此，我们旨在研究糖化血红蛋白（HbA1c）与AIS患者血栓形成风险之间的关联以及炎症的作用。
从中国中医科学院西苑医院纳入1291例AIS患者。采用倾向得分匹配法处理基线不平衡问题。根据入院时初始HbA1c水平是否高于或低于6.5%，将AIS患者分为高HbA1c组（n = 419）和对照组（n = 656）。使用凝血参数评估血栓形成情况。炎症通过中性粒细胞与淋巴细胞比值（NLR）、全身免疫炎症指数（SII）和全身炎症反应指数（SIRI）等标志物反映。采用卡方检验、独立样本t检验、曼-惠特尼U检验和逻辑回归进行相关性分析。
在AIS患者中，HbA1c水平>6.5%与凝血功能异常和炎症反应升高显著相关。在HbA1c升高的AIS患者中，高纤维蛋白原水平与SII和SIRI等炎症标志物升高显著相关。此外，HbA1c>6.5%被确定为AIS患者高凝状态的独立预测因素（β = 1.74，95%CI 1.17 - 2.60，P = 0.006）。
AIS发病后HbA1c水平升高与严重的高凝状态和炎症反应增强相关。HbA1c水平升高可能导致预后较差，可能是由于血栓炎症所致。
