Luo Bin, Xiang Yi, Pan Yueming, Meng Fanlei, Zhang Juanjuan, Liu Zhiguang, Lin Peixian, Zhang Long, Wang Yubo, Ren Hecheng, Ma Lin, Huang Ying
Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, People's Republic of China.
Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, People's Republic of China.
Vasc Health Risk Manag. 2025 Sep 11;21:785-795. doi: 10.2147/VHRM.S530356. eCollection 2025.
To determine the impact of 24-hour post-reperfusion glycemic control on 90-day functional outcomes in acute large vessel occlusion (ALVO) patients after successful recanalization.
This multi-center retrospective study analyzed 2056 ALVO patients (male: 1488; female: 568) from three cerebrovascular centers achieving successful reperfusion via mechanical thrombectomy with/without bridging thrombolysis. Using 1:1 propensity score matching (covariates: gender, age, Diabetes mellitus, hypertension, hyperlipidemia, cardiac disease, smoking status, glucose measurement timing, baseline NIHSS, and preoperative mRS), 194 matched pairs (mean age 63[IQR 55-71] years; male: 278) were stratified by 90-day modified Rankin Scale (mRS) outcomes into favorable (mRS 0-2) and poor prognosis (mRS 3-6) cohorts.
The poor prognosis cohort demonstrated significantly elevated mean fasting blood glucose (MFBG) levels (7.22 mmol/L [6.66-8.50] vs 6.86 mmol/L [6.28-7.58], P<0.001). Multivariable logistic regression adjusted for sex, age, vascular risk profile, and baseline NIHSS (adjusted OR=0.819, 95% CI 0.714-0.940, P=0.004) confirmed MFBG elevation as an independent risk factor for unfavorable outcomes.
Sustained hyperglycemia during the initial 24-hour post-recanalization period independently predicts impaired 90-day functional recovery in ALVO patients. These findings highlight the imperative for standardized glucose monitoring protocols during the hyperacute post-thrombectomy phase, while optimal glycemic targets (<7.0 mmol/L vs individualized thresholds) and therapeutic windows for neuroprotection warrant validation through prospective multicenter RCTs.
确定急性大血管闭塞（ALVO）患者成功再通后24小时再灌注血糖控制对90天功能结局的影响。
这项多中心回顾性研究分析了来自三个脑血管中心的2056例ALVO患者（男性：1488例；女性：568例），这些患者通过机械取栓术伴或不伴桥接溶栓成功实现再灌注。采用1:1倾向评分匹配（协变量：性别、年龄、糖尿病、高血压、高脂血症、心脏病、吸烟状况、血糖测量时间、基线美国国立卫生研究院卒中量表[NIHSS]和术前改良Rankin量表[mRS]），根据90天改良Rankin量表（mRS）结局将194对匹配患者（平均年龄63岁[四分位间距55 - 71岁]；男性：278例）分为预后良好（mRS 0 - 2）和预后不良（mRS 3 - 6）两组。
预后不良组的平均空腹血糖（MFBG）水平显著升高（7.22 mmol/L[6.66 - 8.50] vs 6.86 mmol/L[6.28 - 7.58]，P<0.001）。在对性别、年龄、血管风险概况和基线NIHSS进行多变量逻辑回归调整后（调整比值比=0.819，95%置信区间0.714 - 0.940，P = 0.004），证实MFBG升高是不良结局的独立危险因素。
再通后最初24小时内持续高血糖独立预测ALVO患者90天功能恢复受损。这些发现凸显了在超急性取栓术后阶段制定标准化血糖监测方案的必要性，而最佳血糖目标（<7.0 mmol/L与个体化阈值）以及神经保护的治疗窗口有待通过前瞻性多中心随机对照试验进行验证。
