Correlation between serum fructosamine and hyperglycemia in patients with acute cerebrovascular disease

BACKGROUND: Diabetes mellitus is one of the risk factors in patients with acute cerebral disease, and always leads to stroke or get it worse. There is often a high level of blood glucose in those patients with diabetes mellitus and cerebral disease, but it is hard to distinguish from both kinds of hyperglycemia. Serum fructosamine is said to be correlated with blood glucose. OBJECTIVE: To explore the relationship between serum fructosamine and blood glucose in patients with acute cerebrovascular disease. DESIGN: A case-controlled study. SETTINGS: Department of Clinical Laboratory, Health Department for Cadres and Department of Neurology of Affiliated Hospital, Qingdao University Medical College. PARTICIPANTS: Forty-eight inpatients and outpatients with cerebrovascular diseases were selected from the Department of Neurology, Affiliated Hospital of Qingdao University Medical College from December 2004 to April 2005. All the patients were confirmed with CT and MRI. There were 25 patients with diabetes mellitus secondary cerebrovascular diseases, who met the diagnostic standards of diabetes mellitus set by WHO, including 12 males and 13 females with an average of (60±8) years old, the course of diabetes mellitus ranged from 1 to 21 years.. The other 23 patients had no diabetes mellitus (without diabetes mellitus group), including 14 males and 9 females with an average of (62±6) years old. Meanwhile, another 50 healthy physical examinees in the hospital were selected as control group, including 26 males and 24 females with the average age of (62±5) years old. Informed content was obtained from all the participants. METHODS: Venous blood was drawn from all the participants, and content of blood glucose was assayed by means of glucose oxidase, and the concentration of serum fructosamine was determined by nitroblue tetrazolium colorimetric method. Comparison between groups was performed by the analysis of variance and q test, and the correlation was tested by linear regression analysis. MAIN OUTCOME MEASURES: ① Comparison of blood glucose and serum fructosamine among the groups; ② Correlation between serum fructosamine and blood glucose in patients with diabetes mellitus secondary cerebrovascular diseases and those without diabetes mellitus. RESULTS: All the 48 patients with cerebrovascular disease and 50 healthy subjects were involved in the analysis of results. ① Contents of blood glucose and serum fructosamine: There were obvious differences in the contents of blood glucose and serum fructosamine among the diabetes mellitus group, without diabetes mellitus group and control group (F =577.7, 115.1, P < 0. 01). The content of serum fructosamine in the diabetes mellitus group [(4.25±1.35) mmol/ L] was obviously higher than those in the control group and without diabetes mellitus group [(1.65±0.27), (1.96±0.25) mmol/ L, q =1.47, 1.30, P < 0.01], whereas there was no significant difference between the without diabetes mellitus group and control group (P > 0.05). The content of blood glucose was obviously higher in the patients with and without diabetes mellitus groups [(15.80±2.13), (9.50 ±1.78) mmol/L] than in the control group [(4.56 ±0.77) mmol/L, q =1.86, 2.46, P < 0.01], also markedly higher in the with diabetes mellitus group than in the without diabetes mellitus group (q =1.42, P < 0.01). ② Results of correlation analysis: The content of serum fructosamine was positively correlated with the level of fasting blood glucose in the patients with diabetes mellitus secondary cerebrovascular diseases (r = 0.603, P < 0.01). But there was no relationship between serum fructosamine and fasting blood glucose in the patients without diabetes mellitus (r =0.357, P > 0.05). CONCLUSION: The contents of blood glucose and serum fructosamine were obviously different among the diabetes mellitus group, without diabetes mellitus group and control group. There are closer relations between serum fructosamine and blood glucose in patients with diabetes mellitus secondary cerebral disorders, which are not observed in the patients without diabetes mellitus. Fructosamine is significant in differentiating the reasons for the increased blood glucose in patients with acute cerebrovascular disease.

Trans-cranial Doppler predicts early neurologic deterioration in anterior circulation ischemic stroke after successful endovascular treatment

Background:Early neurologic deterioration(END)may occur in patients with anterior circulation ischemic stroke(ACIS)after receiving endovascular treatment(EVT).Hemodynamic insufficiency,re-occlusion,and post-re-canalization hyper-perfusion are likely to play a critical role in END.We hypothesized that hemodynamic changes can predict END in patients with ACIS postsuccessful EVT using trans-cranial Doppler(TCD).Methods:We utilized a prospectively maintained database of ACIS patients treated with EVT between September 2016 and June 2018 in the Xuanwu Hospital,Capital Medical University.TCD parameters including peak systolic velocity(PSV),bilateral mean flow velocity(MFV),and pulse index(PI)were determined via the middle cerebral arteries within 72 h post-EVT.A logistic regression model was applied to detect independent predictors for END.Results:Totally,112 EVT patients were included in this study and 80/112 patients experienced successful re-canalization with<50%residual stenosis,while 17/80(21.3%)patients suffered END,for which vasogenic cerebral edema(11/17)was considered as a leading role and followed by symptomatic intra-cranial hemorrhage(4/17)and ischemia progression(2/17).For the 80 patients,the PSV(median:127 cm/s vs.116 cm/s,P=0.039),the ratio of ipsilateral-MFV/contra-lateral-MFV(iMFV/cMFV)(median:1.29 vs.1.02,P=0.036)and iMFV/mean blood pressure(MBP)(median:0.97 vs.0.79,P=0.008)in END patients were higher than those of non-END.Using the receiver-operating characteristic curve to obtain cut-off values for PSV,PI,iMFV/cMFV,and iMFV/MBP for END,we found that PI≥0.85(odds ratio:11.03,95%confidence interval:1.92–63.46,P=0.007)and iMFV/MBP≥0.84(odds ratio:9.20,95%confidence interval:2.07–40.84,P=0.004)were independent predictors of END in a multivariate logistic regression model,with a sensitivity of 82.4%and 76.5%and a specificity of 42.9%and 66.7%,respectively,and had the positive predictive values of 29.0%and 38.2%,and negative predictive values of 90.0%and 91.3%,with an area under the receiveroperating characteristic curve of 0.57 and 0.71,respectively.Conclusion:TCD examination of EVT patients may be used as a real-time tool to detect END predictors,such as the higher PI and iMFV/MBP,allowing for better post-thrombectomy management in ACIS patients.