高血糖对急性缺血性脑卒中亚型预后的影响

Effect of hyperglycaemia on prognosis in acute ischemic stroke subtype

目的探讨入院时高血糖对腔隙性脑梗死和非腔隙性脑梗死预后的影响是否一致。方法采用前瞻性队列研究方法,共有248例缺血性卒中患者纳入试验,研究卒中发作8小时内血糖浓度与神经功能预后的关系。有益的终点定义为3个月后改良Rankin量表评分≤2分;根据牛津郡社区卒中计划(OSCP)进行临床分型,并经头颅CT证实为腔隙性脑梗死(n=62)和非腔隙性脑梗死(n=186);高血糖定义为血糖≥8 mmol/L。结果非腔隙性脑梗死组入院时血糖水平、高血压史和意识改变高于腔隙性脑梗死组,差异有统计学意义(P<0.01或<0.05)。单因素分析显示,在腔隙性脑梗死组中,与良好预后比较,不良预后与高龄有关,差异有统计学意义(P<0.05);在非腔隙性脑梗死组中,与良好预后比较,不良预后与高血糖、高龄、意识改变有关,差异有统计学意义(P<0.01或<0.05)。多变量分析显示高血糖与非腔隙性脑梗死预后不良有关(OR=0.71,P=0.008),但能改善腔隙性脑梗死的预后(OR=2.76,P=0.052)。随着血糖上升,在非腔隙性脑梗死中,有益预后的优势比逐渐下降;而在腔隙性脑梗死中,有益预后与血糖≥8 mmol/L有关,但当血糖>10 mmol/L,这种趋势消失。结论高血糖与非腔隙性脑梗死的预后不良有关,但适度高血糖可改善腔隙性脑梗死的预后。

Objective To explore whether the effect of hyperglycaemia on stroke outcome is similar in brain lacunar and non-lacunar infarctions. Methods The relation between serum glucose measured within 8 hours after stroke onset and functional outcome was investigated in 248 ischaemie stroke patients using prospective array method. The endpoint was a favourable outcome,defined as a modified Rankin Scale score ≤2 at 3 months. Classification proved into lacunar infarction （ n = 62） and non-lacunar infarction （ n = 186） ;strokes were based on clinical criteria according to the Oxfordshire Community Stroke Project and findings on brain CT scan. Hyperglycaemia was defined as blood glucose≥8 mmol/L. Results Glucose level,previous hypertension and disorders of consciousness at admission in nonlacunar stroke were higher than those in lacunar stroke,significant differences existed between two groups （ P 〈0.01 or 0.05）. In the univariate analysis, elder age was significantly associated with worse outcome in lacunar group（ P 〈0.05）; hyperglycaemia, elder age and disorders of consciousness were associated with an unfavourable outcome in non- lacunar stroke（ P〈 0.01 or 0.05）. Multivariate analysis showed that hyperglyeaemia was associated with decreased odds of a favourable outcome in non-lacunar stroke （OR = 0.71, P = 0. 008）, but with increased odds of a favourable outcome in lacunar stroke （OR= 2.76, P = 0. 052）. In non-lacunar stroke, there appeared to be a concentration-effect relation,as the odds of favourable outcome gradually decreased with increasing glucose levels. In lacunar stroke, an association with favourable outcome was observed with glucose level 8-10 mmol/L,but this beneficial effect diminished with more severe hyperglycaemia〉10 mmol/L. Conclusion Hyperglycaemia has a detrimental effect in non-lacunar stroke,but moderate hyperglycaemia may be beneficial in lacunar stroke.