脑干梗死与应激性高血糖的相关性

Correlation between brainstem infarction and stress hyperglycemia

目的探讨急性脑干梗死与应激性高血糖的相关性。方法纳入2018年1月1日至2020年5月31日在连云港市第一人民医院神经内科住院的急性缺血性卒中患者。收集患者一般临床资料。入院次日检测空腹血糖(fasting plasma glucose,FPG)及糖化血红蛋白(hemoglobin A1c,HbA1c)。通过应激性高血糖比值(stress hyperglycemia ratio,SHR)评估应激性高血糖,计算方法为FPG(mmol/L)/HbA1c(%)。采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评估入院时神经功能严重程度。对SHR进行四分位数分组(Q1~Q4),比较相关因素在不同四分位数组之间的差异,应用有序多分类logistic回归分析评估脑干梗死与应激性高血糖的相关性。根据发病后3个月时改良Rankin量表(modified Rankin Scale,mRS)评分将患者分为转归良好组(0~2分)和转归不良组(3~6分),应用多变量logistic回归分析评估患者转归不良的独立相关因素。结果共纳入1275例急性缺血性卒中患者,男性765例(60.0%),年龄(65.24±13.13)岁,185例(14.5%)为脑干梗死,599例(47.0%)转归不良。不同水平SHR组在年龄、高血压、糖尿病、入院血压、发病前应用降血糖药物、基线NIHSS评分、脑干梗死、血清甘油三酯、FPG、HbA1c以及发病3个月mRS评分方面差异有统计学意义(P均<0.05)。有序多分类logistic回归分析显示,脑干梗死与高SHR显著独立相关(优势比4.563,95%置信区间1.744~11.939;P=0.002)。转归良好组SHR与转归不良组差异有统计学意义(0.86±0.04对1.01±0.06;P=0.028)。多变量logistic回归分析显示,在校正相关因素后,较高的SHR是患者转归不良的独立相关因素(优势比1.207,95%置信区间1.023~1.408;P=0.037)。结论脑干梗死与急性缺血性卒中患者的应激性高血糖相关,应激性高血糖与急性缺血性卒中患者转归不良相关。

Objective To investigate the correlation between acute brainstem infarction and stress hyperglycemia.Methods Patients with acute ischemic stroke admitted to the Department of Neurology,the First People's Hospital of Lianyungang from January 1,2018 to May 31,2020 were included.The clinical data were collected.On the day after admission,fasting plasma glucose(FPG)and glycated hemoglobin A1c(HbA1c)were tested.The stress hyperglycemia was assessed by stress hyperglycemia ratio(SHR),calculated as FPG(mmol/L)/HbA1c(%).The severity of neurological function at admission was assessed by the National Institutes of Health Stroke Scale(NIHSS).The SHR was divided into quartile groups(Q1 to Q4),and the differences in related factors between different quartile groups were compared.The ordinal multinominal logistic regression analysis was used to evaluate the correlation between brainstem infarction and stress hyperglycemia.According to the modified Rankin Scale(mRS)score at 3 months after onset,patients were divided into a good outcome group(0-2)and a poor outcome group(3-6).Multivariate logistic regression analysis was used to evaluate the independent related factors for poor outcome.Results A total of 1275 patients with acute ischemic stroke were enrolled,including 765 males(60.0%),aged 65.24±13.13 years.One hundred and eighty-five patients(14.5%)were brainstem infarction,and 599(47.0%)had poor outcome.There were significant differences in age,hypertension,diabetes,blood pressure at admission,using hypoglycemic drugs before onset,baseline NIHSS score,brain stem infarction,serum triglycerides,FPG,HbA1c,and mRS score at 3 months in different SHR quartile groups(all P<0.05).Ordinal multinominal logistic regression analysis showed a significant independent correlation between brainstem infarction and high SHR(odds ratio[OR]4.563,95%confidence interval[CI]1.744-11.939;P=0.002).There was a statistically significant difference in SHR between the good outcome group and the poor outcome group(0.86±0.04 vs.1.01±0.06;P=0.028).Multivariate logistic regression analysis showed that after adjusting for related factors,higher SHR was an independent correlated factor for poor outcome(OR 1.207,95%CI 1.023-1.408;P=0.037).Conclusions Brainstem infarction is associated with stress hyperglycemia in patients with acute ischemic stroke.Stress hyperglycemia is associated with poor outcome in patients with acute ischemic stroke.