糖化血红蛋白与脑梗死后出血转化的关系研究

Relationship between glycosylated hemoglobin and hemorrhagic transformation after cerebral infarction

目的出血转化(HT)是脑梗死的主要并发症之一,并可能与临床恶化有关。评估急性前循环卒中患者卒中前慢性高血糖状态是否与HT相关。方法共纳入2014年1月至2016年6月徐州医学院附属连云港医院426例急性前循环脑梗死患者。卒中前血糖状态由糖化血红蛋白(HbA1c)表示。入院后第二天检测HbA1c及空腹血糖(FBG)值。采用美国国立卫生研究院卒中量表(NIHSS)评估入院时神经功能缺损严重程度。以改良Rankin量表(mRS)评估出院时的预后结果。发病后第(4±2)天进行CT或MRI/SWI检查确定是否有HT。采用单因素和多因素Logistic回归分析评估脑梗死后HT和短期预后的危险因素。结果在纳入的426例患者中,93例(21.8%)发生HT,60例(14.1%)为出血性脑梗死,33例(7.7%)为脑实质出血。在多变量分析中,HbA1c和梗死体积是HT的独立预测因子。当患者根据FBG(FBG<7.8 mmol/L或≥7.8 mmol/L)进行分组时,在两组仍可发现HbA1c对HT的预测作用。在多因素Logistic回归分析中,HbA1c也是卒中后不良预后的预测因子(OR=1.482,95%CI 1.228~1.788)。结论缺血性卒中患者HbA1c升高与梗死后HT独立相关,这一结果即使在血糖控制良好的患者中仍然存在,HbA1c也是卒中后不良预后的预测因素。这些发现对于糖尿病和急性前循环梗死患者的血糖管理具有重要意义。

Objective To assess the relationship between hemoglobin A1c(HbA1c)and hemorrhagic cerebral infarction(HI)in patients with acute cerebral infarction.Methods From January 2014 to June 2016,in the Lianyungang Hospital Affiliated to Xuzhou Medical University,426 patients with acute anterior circulation infarction were included.The blood sugar status before stroke was expressed by HbA1c.HbA1c and fasting blood glucose(FBG)were measured on the second day after admission.The National Institutes of Health Stroke Scale(NIHSS)was used to assess the severity of neurological function at admission.The modified Rankin scale(mRS)was used to evaluate the prognosis at discharge.CT or MRI/SWI examination was performed to determine whether there was HT.Logistic regression was used to evaluate the risk factors for HT and short-term prognosis after cerebral infarction.Results Of the 426 patients enrolled,93(21.8%)appeared HT,60(14.1%)had hemorrhagic cerebral infarction(HI)and 33(7.7%)had parenchymal hemorrhage(PH).Multivariate analysis showed that HbA1c and infarct volume were independent predictor of HT.When patients were grouped according to fasting blood glucose(FBG<7.8 mmol/L or≥7.8 mmol/L),the predictive effect of HbA1c on HT was found in both groups.In multiple Logistic regression analysis,HbA1c was also a predictor of poor prognosis after stroke(OR=1.482,95%CI 1.228-1.788).Conclusions In patients with ischemic stroke,elevated HbA1c is independently associated with post-infarction HT,and this result doesn′t change even in patients with well-controlled blood glucose.HbA1c is also a predictor of poor prognosis after stroke.These findings are important for blood glucose management in patients with diabetes and acute anterior circulation infarction.