早期高血糖对原发性脑出血患者近期预后影响的汇总分析

The effects of acute hyperglycemia on short-term prognosis in patients with primary intracerebral hemorrhage： a meta-analysis

目的通过汇总分析方法评价早期高血糖对原发性脑出血（intracerebral hemorrhage，ICH）患者近期预后的影响。方法检索报道ICH患者入院24h内基线血糖水平与近期预后（至少随访至出院或1个月）关系的前瞻性或回顾性队列研究或病例对照研究，应用汇总分析软件包RevMan4．2对符合纳入标准的文献进行数据合并，并进行发表偏倚分析和敏感性分析评价结果的稳定性。结果正常血糖组患者在随访结束时的死亡风险显著低于高血糖组（优势比=0．24，95％ CI0．19～0．30；P〈0．00001）；存活组患者基线血糖水平显著低于死亡组（加权平均差=-2．30，95％CI-2．36～-2．23；P〈0．00001）。结论早期高血糖可显著增高原发性ICH患者近期死亡风险，有必要进行前瞻性随机试验，以探讨强化血糖控制对ICH患者预后的影响。

Objective To evaluate the impact of acute hyperglycemia on the short-term prognosis in patients with primary intracerebral hemorrhage （ICH） with meta-analysis. Methods The prospective or retrospective cohort studies or case-control studies of the relationship between baseline blood glucose levels and short-term prognosis （at least were followed up to discharge or 1 month） in patients with ICH within 24 hours were searched and reported. A meta- analysis software package （RevMan 4.2） was used to pool data for the literatures in accordance with the inclusion criteria. The publication bias was analyzed and the sensitivity analysis was used to evaluate the stability of the results, Results The risk of mortality at the end of the follow up in the normoglycemia group was significantly lower than that in the hyperglycemia group （odds ratio 0.24, 95% CI 0.19-0.30; P 〈0. 000 01）; the baseline plasma glucose level was significantly lower than that in the survival group （weighted mean difference -2.30, 95 % Cl - 2.36- - 2.23; P 〈 0. 000 01 ）. Conclusions Acute hyperglycemia can significantly increase the risks of short-term mortality in patients with primary ICH. It is necessary to conduct a prospective randomized trial in order to investigate the effect of intensive glucose control on the prognosis of the patients with ICH.