应激性高血糖指数预测血管内治疗后血管成功再通的急性缺血性卒中患者转归

Stress hyperglycemia ratio predicts the outcome of successful recanalization after endovascular treatment in patients with acute ischemic stroke

目的探讨应激性高血糖指数(stress hyperglycemia ratio,SHR)与急性缺血性卒中血管内治疗后成功再通患者转归不良的相关性。方法回顾性纳入2019年1月至2022年10月在连云港市第二人民医院接受血管内治疗且血管成功再通的急性缺血性卒中患者。SHR定义为空腹血糖与糖化血红蛋白的比值。在术后90 d采用改良Rankin量表评分评估患者转归,0~3分定义为转归良好,>3分定义为转归不良。应用多变量logistic回归分析确定患者转归不良的独立危险因素。采用受试者工作特征曲线评估SHR对急性缺血性卒中血管内治疗后成功再通患者90 d转归不良的预测价值。结果共纳入159例患者,男性98例(61.6%),年龄(69.8±8.9)岁,基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(12.6±4.3)分,SHR为1.17±0.46。105例(66.0%)转归良好,54例(34.0%)转归不良。转归不良组SHR、空腹血糖、糖化血红蛋白、基线NIHSS评分以及侧支循环不良和有症状颅内出血的患者构成比与转归良好差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,SHR为转归不良的独立预测因素(优势比2.254,95%置信区间1.136~4.278;P<0.001)。受试者工作特征曲线分析显示,SHR预测转归不良的曲线下面积为0.726(95%置信区间0.648~0.804;P<0.001),高于空腹血糖和糖化血红蛋白。SHR的最佳截断值为1.21,预测转归不良的敏感性和特异性分别为66.23%和75.82%。结论SHR与血管内治疗后血管成功再通的急性缺血性卒中患者转归不良有关,可作为潜在的预测指标。

Objective To investigate the correlation between stress hyperglycemia ratio(SHR)and poor outcome of successful recanalization after endovascular treatment in patients with acute ischemic stroke.Methods From January 2019 to October 2022,patients with acute ischemic stroke received endovascular treatment and successful recanalization in the Second People’s Hospital of Lianyungang were included retrospectively.SHR was defined as the fasting blood sugar and glycosylated hemoglobin ratio.At 90 d after procedure,the outcome of patients was evaluated using the modified Rankin Scale score.0-3 was defined as good outcome,and>3 was defined as poor outcome.Multivariate logistic regression analysis was used to determine the independent risk factor for poor outcome.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of SHR for 90 d poor outcome in patients with successful recanalization after endovascular treatment.Results A total of 159 patients were enrolled,including 98 males(61.6%),aged 69.8±8.9 years old.The baseline National Institutes of Health Stroke Scale(NIHSS)score was 12.6±4.3,and SHR was 1.17±0.46.One hundred and five patients(66.0%)had good outcome,while 54(34.0%)had poor outcome.There were statistically significant differences in SHR,fasting blood glucose,glycosylated hemoglobin,baseline NIHSS score and the proportion of patients with poor collateral circulation and symptomatic intracranial hemorrhage between the poor outcome group and the good outcome group(all P<0.05).Multivariate logistic regression analysis showed that SHR was an independent predictor of poor outcome(odds ratio 2.254,95%confidence interval 1.136-4.278;P<0.001).The ROC curve analysis showed that the area under the curve of SHR for predicting poor outcome was 0.726(95%confidence interval 0.648-0.804;P<0.001),which was higher than fasting blood glucose and glycosylated hemoglobin.The optimal cutoff value for SHR was 1.21,and the sensitivity and specificity for predicting poor outcomes were 66.23%and 75.82%,respectively.Conclusion SHR is associated with the poor outcome of successful recanalization after endovascular treatment in patients with acute ischemic stroke and can be used as a potential predictor.