Jørgensen H, Nakayama H, Raaschou H O, Olsen T S
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Stroke. 1994 Oct;25(10):1977-84. doi: 10.1161/01.str.25.10.1977.
Although diabetes is a strong risk factor for stroke, it is still unsettled whether stroke is different in patients with and without diabetes. This is true for stroke type, stroke severity, the prognosis, and the relation between admission glucose levels and stroke severity/mortality.
This community-based study included 1135 acute stroke patients (233 [20%] had diabetes). All patients were evaluated until the end of rehabilitation by weekly assessment of neurological deficits (Scandinavian Stroke Scale) and functional disabilities (Barthel Index). A computed tomographic scan was performed in 83%.
The diabetic stroke patient was 3.2 years younger than the nondiabetic stroke patient (P < .001) and had hypertension more frequently (48% versus 30%, P < .0001). Intracerebral hemorrhages were six times less frequent in diabetic patients (P = .002). Initial stroke severity, lesion size, and site were comparable between the two groups. However, mortality was higher in diabetic patients (24% versus 17%, P = .03), and diabetes independently increased the relative death risk by 1.8 (95% confidence interval [CI], 1.04 to 3.19). Outcome was comparable in surviving patients with and without diabetes, but patients with diabetes recovered more slowly. Mortality increased with increasing glucose levels on admission in nondiabetic patients independent of stroke severity (odds ratio, 1.2 per 1 mmol/L; CI, 1.01 to 1.42; P = .04). This was not the case in diabetic patients.
Diabetes influences stroke in several aspects: in age, in subtype, in speed of recovery, and in mortality. Increased glucose levels on admission independently increase mortality from stroke in nondiabetic but not in diabetic patients. The effect of reducing high admission glucose levels in nondiabetic stroke patients should be examined in future trials.
尽管糖尿病是中风的一个重要危险因素，但中风在糖尿病患者和非糖尿病患者中是否存在差异仍未明确。在中风类型、中风严重程度、预后以及入院血糖水平与中风严重程度/死亡率之间的关系方面均是如此。
这项基于社区的研究纳入了1135例急性中风患者（233例[20%]患有糖尿病）。通过每周评估神经功能缺损（斯堪的纳维亚中风量表）和功能障碍（巴氏指数）对所有患者进行评估，直至康复结束。83%的患者进行了计算机断层扫描。
糖尿病中风患者比非糖尿病中风患者年轻3.2岁（P <.001），且高血压发生率更高（48%对30%，P <.0001）。糖尿病患者脑出血的发生率低6倍（P =.002）。两组患者的初始中风严重程度、病灶大小和部位相当。然而，糖尿病患者的死亡率更高（24%对17%，P =.03），糖尿病独立使相对死亡风险增加1.8（95%置信区间[CI]，1.04至3.19）。存活的糖尿病患者和非糖尿病患者的预后相当，但糖尿病患者恢复较慢。在非糖尿病患者中，入院时血糖水平升高与中风严重程度无关，死亡率增加（比值比，每1 mmol/L为1.2；CI，1.01至1.42；P =.04）。糖尿病患者并非如此。
糖尿病在多个方面影响中风：年龄、亚型、恢复速度和死亡率。入院时血糖水平升高独立增加非糖尿病患者而非糖尿病患者的中风死亡率。未来的试验应研究降低非糖尿病中风患者高入院血糖水平的效果。
