Elevated Fasting Blood Glucose Is Predictive of Poor Outcome in Non-Diabetic Stroke Patients: A Sub-Group Analysis of SMART.
Elevated Fasting Blood Glucose Is Predictive of Poor Outcome in Non-Diabetic Stroke Patients: A Sub-Group Analysis of SMART.
复制标题
空腹血糖升高可以预测非糖尿病中风患者的预后不良：SMART的亚组分析。
DOI：
10.1371/journal.pone.0160674
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
SMART investigators
中科院分区：
文献类型：
--
作者：
Yao M;Ni J;Zhou L;Peng B;Zhu Y;Cui L;SMART investigators
尽管越来越多的证据表明急性脑卒中后高血糖会对临床结果产生不利影响，但在未预先诊断糖尿病的脑卒中患者中，血糖和功能结局之间的关联是否存在差异仍存在争议。在SMART队列的一个亚组中，我们的目的是研究空腹血糖（FBG）与6个月功能结局之间的关系，并进一步评估这种关联是否会因糖尿病的预诊断状态而变化。对SMART队列中2862例急性缺血性脑卒中患者（其中629例为糖尿病前期患者）的数据进行分析。脑卒中后6个月的功能结局采用改良Rankin量表（mRS）进行测量，分为良好（mRS: 0-2）和差（mRS: 3-5）。采用二元logistic回归模型，调整年龄、性别、教育程度、高血压和脑卒中史、基线NIHSS和治疗组等因素，评价入院FBG与功能结局的关系。根据是否有糖尿病前期病史进一步进行分层logistic回归分析。在整个队列中，多变量逻辑回归显示，功能不良与空腹血糖升高（OR1.21 (95% ci 1.07-1.37), p = 0.002），年龄较大（OR1.64 (95% CI1.38-1.94), p<0.001）， NIHSS升高（OR2.90 (95% ci 2.52-3.33), p<0.001）和高血压（OR1.42 (95% ci 1.13-1.98), p = 0.04）相关。分层逻辑回归分析显示，FBG与功能结局之间的相关性仅在未诊断为糖尿病的患者中保持显著（OR1.26 (95%CI 1.03-1.55), p = 0.023），而在病前诊断为糖尿病的患者中则无显著性（p = 0.885）。目前的研究结果表明，在没有预先诊断糖尿病的患者中，卒中后FBG升高与功能不良之间存在显著关联，但在糖尿病患者中没有。这一发现证实了在缺血性卒中急性期控制血糖的重要性，特别是在没有预先诊断糖尿病的患者中。因此，进一步研究高血糖环境下控制血糖水平的最佳策略具有重要意义。ClinicalTrials.gov NCT00664846
Although increasing evidence suggests that hyperglycemia following acute stroke adversely affects clinical outcome, whether the association between glycaemia and functional outcome varies between stroke patients with\without pre-diagnosed diabetes remains controversial. We aimed to investigate the relationship between the fasting blood glucose (FBG) and the 6-month functional outcome in a subgroup of SMART cohort and further to assess whether this association varied based on the status of pre-diagnosed diabetes. Data of 2862 patients with acute ischemic stroke (629 with pre-diagnosed diabetics) enrolled from SMART cohort were analyzed. Functional outcome at 6-month post-stroke was measured by modified Rankin Scale (mRS) and categorized as favorable (mRS:0–2) or poor (mRS:3–5). Binary logistic regression model, adjusting for age, gender, educational level, history of hypertension and stroke, baseline NIHSS and treatment group, was used in the whole cohort to evaluate the association between admission FBG and functional outcome. Stratified logistic regression analyses were further performed based on the presence/absence of pre-diabetes history. In the whole cohort, multivariable logistical regression showed that poor functional outcome was associated with elevated FBG (OR1.21 (95%CI 1.07–1.37), p = 0.002), older age (OR1.64 (95% CI1.38–1.94), p<0.001), higher NIHSS (OR2.90 (95%CI 2.52–3.33), p<0.001) and hypertension (OR1.42 (95%CI 1.13–1.98), p = 0.04). Stratified logistical regression analysis showed that the association between FBG and functional outcome remained significant only in patients without pre-diagnosed diabetes (OR1.26 (95%CI 1.03–1.55), p = 0.023), but not in those with premorbid diagnosis of diabetes (p = 0.885). The present results demonstrate a significant association between elevated FBG after stroke and poor functional outcome in patients without pre-diagnosed diabetes, but not in diabetics. This finding confirms the importance of glycemic control during acute phase of ischemic stroke especially in patients without pre-diagnosed diabetes. Further investigation for developing optimal strategies to control blood glucose level in hyperglycemic setting is therefore of great importance. ClinicalTrials.gov NCT00664846