Słowik A, Zwolińska G, Tomik B, Wyrwicz-Petkow U, Szczudlik A
Kliniki Neurologii Instytutu Neurologii Collegium Medicum U.J., Krakowie.
Neurol Neurochir Pol. 1998 Mar-Apr;32(2):317-29.
Experimental studies of different stroke models equivocally showed that hyperglycaemia is responsible for the increase of infarct volume and mortality. Similar results were obtained in several, but not all clinical studies. The aim of the study was to assess the occurrence and prognosis of transient hyperglycaemia in non-diabetic, acute ischaemic stroke patients. A consecutive series of 204 patients admitted to the Stroke Unit within 48 hours after the onset of the first-ever hemispheric ischaemic stroke, confirmed by CT and/or autopsy, were included in the study. Blood samples for determination of glucose level were obtained immediately after admission, on the 1-st, 2-nd, 3-rd, 5-th, 7-th and 14-th day of stroke. The fructosamine and HbA1 measurements were used to exclude patients with previous glucose intolerance. The severity of stroke was assessed according to Scandinavian Neurological Stroke Scale on admission, on the first, 7-th, 14-th and 30-th day of stroke. Transient hyperglycaemia, defined as at least one elevated glucose level in the first week of stroke with normal level of HbA1 and fructosamine was found in 65 (31.9%) of patients. Patients with transient hyperglycaemia did not differ from diabetics and normoglycaemic according to age, gender, history of hypertension and other risk factors. 30 day mortality in the group of patients with transient hyperglycaemia was significantly higher than in normoglycaemic ( p. < 0.001) and diabetic patients. Transient hyperglycaemic patients died earlier, mainly on the 7-th day after admission whereas patients with normoglycaemia died mainly on the 18-th day (p < 0.0001). The main reason of death in hyperglycaemic patients were cardiac complications (15/20), in normoglycaemic--the consequences of immobility (8/11) (< 0.01). The results of our study showed that the transient hyperglycaemia occurred in about one third of acute ischaemic stroke patients and resulted in higher 30-day mortality.
不同中风模型的实验研究结果不一，显示高血糖与梗死体积增大和死亡率增加有关。在一些但并非所有的临床研究中也得到了类似结果。本研究的目的是评估非糖尿病急性缺血性中风患者短暂性高血糖的发生率及预后情况。本研究纳入了连续的204例患者，这些患者在首次半球缺血性中风发作后48小时内入住卒中单元，经CT和/或尸检确诊。入院后即刻、中风第1、2、3、5、7和14天采集血样测定血糖水平。使用果糖胺和糖化血红蛋白测量结果排除既往有糖耐量异常的患者。根据斯堪的纳维亚神经学卒中量表在入院时、中风第1、7、14和30天评估中风严重程度。65例（31.9%）患者出现短暂性高血糖，定义为中风第一周内至少有一次血糖水平升高且糖化血红蛋白和果糖胺水平正常。短暂性高血糖患者在年龄、性别、高血压病史和其他危险因素方面与糖尿病患者和血糖正常者无差异。短暂性高血糖患者组的30天死亡率显著高于血糖正常患者（p<0.001）和糖尿病患者。短暂性高血糖患者死亡较早，主要在入院后第7天，而血糖正常患者主要在第18天死亡（p<0.0001）。高血糖患者的主要死亡原因是心脏并发症（15/20），血糖正常患者的主要死亡原因是活动受限的后果（8/11）（<0.01）。我们的研究结果表明，约三分之一的急性缺血性中风患者出现短暂性高血糖，并导致30天死亡率升高。
