应激性血糖升高比值对急性缺血性脑卒中临床预后的关联性分析及预测价值

Correlation analysis and predictive value of stress hyperglycemia ratio for clinical prognosis of acute ischemic stroke

目的探讨应激性血糖升高比值(stress hyperglycemia ratio,SHR)与急性缺血性脑卒中(acute ischemic stroke,AIS)1年预后的相关性,为改善AIS患者的预后并针对性控制影响因素提供更多的临床依据。方法回顾性连续纳入2019年5月—2022年1月在石家庄市第五医院初次诊断治疗的AIS患者。根据患者发病后1年改良Rankin量表评分分为预后良好组及预后差组,并根据SHR的中位数分为2组。分析SHR与应激性血糖的相关性,并确定影响AIS患者预后的因素。采用受试者操作特征曲线比较SHR与应激性血糖对AIS患者预后的预测价值。结果共纳入患者206例。其中,预后良好组125例(60.7%),预后差组81例(39.3%);SHR中位数(下四分位数,上四分位数)为1.20(1.08,1.33)。两组的入院美国国立卫生研究院卒中量表评分、糖尿病史、高血压病史、低密度脂蛋白胆固醇、应激性血糖、年龄、SHR及SHR分类比较,差异均有统计学意义(P<0.05);其余指标两组比较,差异均无统计学意义(P>0.05)。应激性血糖与SHR呈正相关(7.95±1.78 vs.1.21±0.19;r=0.294,P<0.001)。多因素logistic分析结果显示,应激性血糖及SHR均是AIS患者1年预后的独立影响因素(P<0.05),SHR同糖尿病交互作用不显著(P>0.05)。调整混杂因素后,SHR对AIS患者预后的受试者操作特征曲线下面积较应激血性糖高[0.682(0.614,0.745)vs.0.585(0.515,0.653);Z=2.042,P=0.041]。结论SHR与应激性血糖均是AIS患者1年预后的独立风险因素,但SHR对AIS患者1年预后的预测价值优于应激性血糖。无论患者是否存在糖尿病,SHR对AIS患者预后的影响一致。

Objective To investigate the correlation between stress hyperglycemia ratio(SHR)and acute ischemic stroke(AIS)1-year prognosis,to provide more clinical basis to improve the prognosis of AIS patients and to target and control the influencing factors.Methods The patients with AIS diagnosed for the first time and received treatment at the Shijiazhuang Fifth Hospital between May 2019 and January 2022 were retrospectively and continuously included.According to the Modified Rankin Scale score 1-year after the onset of the disease,the patients were divided into a good prognosis group and a poor prognosis group.Also the patients were divided into 2 groups based on the median of SHR.The correlation between SHR and stress blood glucose was analyzed,and the factors affecting the prognosis of AIS patients were identified.The predictive value of SHR and stress blood glucose on the prognosis of AIS patients was compared using receiver operating characteristic.Results A total of 206 patients were included.Among them,there were 125 cases(60.7%)in the good prognosis group and 81 cases(39.3%)in the poor prognosis group.The median SHR(lower quartile,upper quartile)is 1.20(1.08,1.33).There were statistically significant differences between the two groups in the scores of the National Institutes of Health Stroke Scale,diabetes history,hypertension history,low-density lipoprotein cholesterol,stress blood glucose,age,SHR and SHR classification(P<0.05).There was no statistically significant difference in the other indicators compared between the two groups(P>0.05).Stress blood glucose was positively correlated with SHR(7.95±1.78 vs.1.21±0.19;r=0.294,P<0.001).Multivariate logistic analysis showed that stress blood glucose and SHR were independent factors influencing the 1-year prognosis of AIS patients(P<0.05),and the interaction between SHR and diabetes was not significant(P>0.05)After adjusting for confounding factors,the area under the receiver operating characteristic curve of SHR for the prognosis of AIS patients was higher than that of stress blood glucose[0.682(0.614,0.745)vs.0.585(0.515,0.653);Z=2.042,P=0.041].Conclusions SHR and stress blood glucose are independent risk factors for 1-year prognosis in AIS patients.However,SHR has a better predictive value for 1-year prognosis in AIS patients than stress blood glucose.Whether the patient has diabetes or not,the impact of SHR on the prognosis of AIS patients is consistent.