Toni D, De Michele M, Fiorelli M, Bastianello S, Camerlingo M, Sacchetti M L, Argentino C, Fieschi C
Department of Neurological Sciences, University La Sapienza, Rome, Italy.
J Neurol Sci. 1994 May;123(1-2):129-33. doi: 10.1016/0022-510x(94)90214-3.
We investigated the effects of hyperglycaemia on infarct size of 82 acute ischaemic stroke patients with angiographically diagnosed intracranial occlusion in middle cerebral artery territory. There were 9 diabetics, 40 non-diabetic hyperglycaemics and 33 non-diabetic normoglycaemics (mean age 67 +/- 8 SD years, male/female ratio 1:1). For each patient the infarct at CT was compared to that predicted from the location of the arterial occlusion. The extent of the infarct was then classified as equal to, smaller than and larger than estimated, taking a standard anatomical template of arterial territories as reference. The results were analysed separately according to the presence or absence of a collateral blood supply (CBS) at angiography. The clinical outcome at 30 days was also evaluated. The 35 patients lacking CBS had a high frequency of equal to estimated lesions (75%), without substantial differences among the three subgroups (72% of hyperglycaemics, 82% of normoglycaemics and 67% of diabetics; Fisher's exact test not significant for any of the pairwise comparisons). On the contrary, the 47 patients with CBS exhibited an overall predominance of smaller than estimated lesions (66%) but with a very uneven distribution among hyperglycaemics, normoglycaemics and diabetics (82%, 64% and 0%, respectively; p < 0.05 at Fisher's exact test for diabetics vs hyperglycaemics). Finally, the clinical outcome was bad (death and neurological impairment) in 89% of diabetics, 72% of hyperglycaemics and 54% of normoglycaemics (p < 0.05). These results suggest that in patients with intracranial arterial occlusion associated with CBS the effects of hyperglycaemia might be beneficial in non-diabetics and harmful in diabetics.(ABSTRACT TRUNCATED AT 250 WORDS)
我们研究了高血糖对82例急性缺血性中风患者梗死面积的影响，这些患者经血管造影诊断为大脑中动脉区域颅内闭塞。其中有9例糖尿病患者、40例非糖尿病高血糖患者和33例非糖尿病正常血糖患者（平均年龄67±8标准差岁，男女比例1:1）。对每位患者，将CT上的梗死灶与根据动脉闭塞位置预测的梗死灶进行比较。然后以动脉区域的标准解剖模板为参照，将梗死范围分为等于、小于和大于估计值。根据血管造影时是否存在侧支血供（CBS）分别分析结果。还评估了30天时的临床结局。35例缺乏CBS的患者中，梗死灶等于估计值的频率较高（75%），三个亚组之间无显著差异（高血糖患者72%，正常血糖患者82%，糖尿病患者67%；Fisher精确检验对任何两两比较均无显著性）。相反，47例有CBS的患者总体上梗死灶小于估计值占优势（66%），但在高血糖患者、正常血糖患者和糖尿病患者中的分布非常不均（分别为82%、64%和0%；糖尿病患者与高血糖患者比较，Fisher精确检验p<0.05）。最后，89%的糖尿病患者、72%的高血糖患者和54%的正常血糖患者临床结局不良（死亡和神经功能缺损）（p<0.05）。这些结果表明，在伴有CBS的颅内动脉闭塞患者中，高血糖对非糖尿病患者可能有益，对糖尿病患者可能有害。（摘要截短于250字）
