入院时高血糖与急性缺血性卒中患者静脉溶栓治疗后转归的相关性

Correlation between hyperglycemia at admission and outcome after intravenous thrombolysis in patients with acute ischemic stroke

目的 探讨入院时血糖水平对急性缺血性卒中(acute ischemic stroke,AIS)患者静脉溶栓治疗后转归和出血性转化的影响.方法 回顾性纳入2013年12月至2017年1月在徐州市中心医院神经内科接受静脉溶栓治疗的AIS患者.根据入院时血糖水平分为非高血糖组(≤8 mmol/L)和高血糖组(>8 mmol/L).在发病后90 d时采用改良Rankin量表(modified Rankin Scale,mRS)评价功能转归,0~2分定义为转归良好,>2分定义为转归不良.在治疗后24 h^7 d期间复查CT明确有无颅内出血.应用多变量logistic回归分析确定静脉溶栓治疗后患者转归的独立影响因素.结果共纳入323例AIS患者.非高血糖组237例(73.4%),高血糖组86例(26.6%);转归良好组238例(73.7%),转归不良组85例(26.3%);出血性转化组25例(7.7%),非出血性转化组298例(92.3%).单变量分析显示,转归不良组与转归良好组缺血性心脏病、心房颤动、既往卒中或短暂性脑缺血发作史患者的构成比以及年龄、基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分和基线血糖差异有统计学意义(P均<0.05);出血性转化组与非出血性转化组高血压患者的构成比和基线NIHSS评分差异有统计学意义(P均<0.05).多变量logistic回归分析显示,入院时高血糖[优势比(odds ratio,OR)2.239,95% 可信区间(confidence interval,CI)1.210~4.143;P=0.010]和基线NIHSS评分(OR 3.528,95%CI 2.451~5.078;P<0.001)是转归不良的独立影响因素;高血压(OR 0.410,95%CI 0.173~0.972;P=0.043)和基线NIHSS评分(OR 2.283,95%CI 1.382~3.772;P=0.001)是出血性转化的独立影响因素.结论 入院时高血糖是AIS 患者静脉溶栓治疗后转归不良的独立危险因素,但与出血性转化风险无关.

Objective To investigate the effect of blood glucose levels at admission on the outcomes and hemorrhagic transformation in patients with acute ischemic stroke (AIS) after intravenous thrombolysis. Methods From December 2013 to January 2017, patients with AIS treated with intravenous thrombolysis at the Department of Neurology, Xuzhou Central Hospital were enrolled retrospectively. According to the blood glucose levels on admission, they were divided into non-hyperglycemic group ( ≤8 mmol/L ) and hyperglycemic group ( > 8 mmol/L). The functional outcome was assessed with the modified Rankin Scale score at 90 d after onset, and 0-2 was defined as good outcome and > 2 was defined as poor outcome. From 24 h to 7 d after treatment, CT scan was performed again to determine whether there was intracranial hemorrhage or not. Multivariate logistic regression analysis was used to identify the independent influencing factors of outcomes after intravenous thrombolysis. Results A total of 323 patients with AIS were enrolled, including 237 (73. 4%) in the non-hyperglycemic group and 86 (26. 6%) in the hyperglycemic group; 238 (73. 7%) in the good outcome group, and 85 (26. 3%) in the poor outcome group; 25 (7. 7%) in the hemorrhagic transformation group, and 298 (92. 3%) in the non-hemorrhagic transformation group. Univariate analysis showed that there were significant differences in the proportions of patients with ischemic heart disease, atrial fibrillation, past history of stroke or TIA, as well as age, baseline National Institutes of Health Stroke Scale (NIHSS) score, and baseline blood glucose between the poor outcome group and the good outcome group (all P < 0. 05). There were significant differences in the proportion of hypertensive patients and baseline NIHSS score between the hemorrhagic transformation group and the non- hemorrhagic transformation group ( all P < 0. 05 ). Multivariate logistic regression analysis showed that hyperglycemia at admission (odds ratio [OR] 2. 239, 95% confidence interval [CI] 1. 210-4. 143; P = 0. 010)and baseline NIHSS score (OR 3. 528, 95% CI 2. 451-5. 078; P < 0. 001) were the independent influencing factors of poor outcome; hypertension (OR 0. 410, 95% CI 0. 173-0. 972; P = 0. 043 ) and baseline NIHSS score (OR 2. 283, 95% CI 1. 382-3. 772, P = 0. 001 ) were the independent influencing factors of hemorrhagic transformation. Conclusion Hyperglycemia at admission was an independent risk factor for poor outcome in patients with AIS after intravenous thrombolytic therapy, but it was not associated with the risk of hemorrhagic transformation.