Short-term glycemic variability and hemorrhagic transformation after successful endovascular thrombectomy
Short-term glycemic variability and hemorrhagic transformation after successful endovascular thrombectomy
复制标题
DOI：
10.1007/s12975-021-00895-4
复制
发表时间：
2021-02-12
影响因子：
6.9
通讯作者：
Ko, Sang-Bae
中科院分区：
文献类型：
--
作者：
Kim, Tae Jung;Lee, Ji Sung;Ko, Sang-Bae
背景：血糖变异性（GV）是缺血性卒中后不良预后的危险因素。然而，其对血管内再通治疗（ERT）后出血转化的影响仍有待阐明。方法选取2013年1月至2019年11月期间因大血管闭塞而行ERT（改良溶栓治疗脑梗死2b或3）后再通成功的急性缺血性卒中患者。获取ERT后前36 h的血糖水平数据，并评估葡萄糖变化时间率（TR）等10项GV参数。葡萄糖变化的TR反映了监测期间葡萄糖随时间波动的速度（mg/dL/h）。分析ERT术后3个月症状性脑出血（siich）及不良预后。sICH定义为2型实质血肿，在美国国立卫生研究院卒中量表上神经功能恶化4分或以上。此外，修改后的Rankin量表3-6在3个月时被认为是一个不利的结果。结果176例患者（平均年龄69.3岁，女性47.7%）中，16例（9.1%）患者在ERT成功后发生siich。此外，54% （n = 95）患者在3个月时出现不良结果。结果不良的sICH患者的TR值较高。在调整潜在混杂因素后，葡萄糖TR（每增加1 mg/dL/h）变化与sICH（优势比1.17；95%可信区间[CI]， 1.012-1.343）和3个月不良结局（OR 1.14, 95% CI, 1.000-1.297）独立相关。结论：与任何GV参数相比，ERT成功后前36小时的时间相关GV与sICH和不良功能预后的相关性更强。这表明，维持稳定的葡萄糖可能是成功ERT后预防sICH的一个重要因素。
Background Glycemic variability (GV) is a risk factor for poor outcomes after ischemic stroke. However, its effect on hemorrhagic transformation after endovascular recanalization therapy (ERT) remains to be elucidated. Methods Patients with acute ischemic stroke due to large vessel occlusion with successful recanalization after ERT (modified thrombolysis in cerebral infarction 2b or 3) were enrolled between January 2013 and November 2019. Blood glucose level data were obtained during the first 36 h after ERT, and ten GV parameters including time rate (TR) of glucose variation were assessed. The TR of glucose variation reflects the speed of glucose fluctuations over time (mg/dL/hour) during the monitoring period. Symptomatic intracerebral hemorrhage (sICH) and unfavorable outcomes at 3 months after ERT were analyzed. The sICH was defined as parenchymal hematoma type 2 with a neurological deterioration of 4 points or more on the National Institute of Health Stroke Scale. Moreover, a modified Rankin Scale of 3-6 at 3 months was considered an unfavorable outcome. Results Among all patients (n = 176; mean age, 69.3 years; 47.7 % female), sICH developed after successful ERT in 16 (9.1%) patients. In addition, 54% (n = 95) patients had an unfavorable outcome at 3 months. Patients with sICH and unfavorable outcome had higher the TR of glucose variation. After adjusting for potential confounders, the TR of glucose (per 1 mg/dL/h increase) variation was independently associated with sICH (odds ratio, 1.17; 95% confidence interval [CI], 1.012-1.343) and 3-month unfavorable outcome (OR 1.14, 95% CI, 1.000-1.297). Conclusions Time-related GV during the first 36 h after successful ERT has a stronger correlation with sICH and poor functional outcomes compared to any GV parameters. This suggests that maintaining stable glucose may be an important factor in the prevention of sICH after undergoing successful ERT.