Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial
Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial
复制标题
DOI：
10.1212/wnl.59.5.669
复制
发表时间：
2002-09-10
期刊：
影响因子：
9.9
通讯作者：
Fineberg, SE
中科院分区：
文献类型：
--
作者：
Bruno, A;Levine, SR;Fineberg, SE
背景：急性缺血性脑卒中期间的高血糖可能增加脑损伤，易发生脑出血（ICH），或两者兼而有之。方法：利用美国国立神经疾病与卒中研究所重组组织型纤溶酶原激活剂（rt-PA）卒中试验数据进行多元回归分析，分析急性缺血性卒中患者入院时血糖水平与临床结局的关系。神经系统改善被定义为在NIH卒中量表上从基线到3个月改善4分或以上，或最终得分为零。3个月时，格拉斯哥预后评分为1分，Barthel指数为95 - 100分，均为良好预后。症状性脑出血被定义为在治疗36小时内，有ct记录的与临床恶化有关的暂时性出血。控制潜在的混杂因素，包括急性治疗（rt-PA或安慰剂）、年龄、基线NIH卒中量表评分、糖尿病史、卒中亚型和入院血压。结果：624例患者在卒中发生后3小时内入组。随着入院血糖升高，神经系统改善的几率降低（入院血糖每增加100 mg/dL，比值比[OR] = 0.76, 95% CI 0.61 ~ 0.95, p = 0.01）。入院血糖与预后良好的关系取决于入院平均血压（MBP）：随着入院平均血压（MBP）的升高，入院血糖水平升高相关的预后良好的几率逐渐降低（p = 0.02）。随着入院血糖升高，出现症状性脑出血的几率也增加（入院血糖每增加100 mg/dL OR = 1.75, 95% CI 1.11 ~ 2.78, p = 0.02）。入院时血糖水平与rt-PA疗效的改变无关。结论：在急性缺血性卒中患者中，无论采用rt-PA治疗，入院时较高的血糖水平与理想临床结局的几率显著降低和症状性脑出血的几率显著升高相关。这是否代表一种因果关系还有待确定。
Background: Hyperglycemia during acute ischemic stroke may augment brain injury, predispose to intracerebral hemorrhage (ICH), or both. Method: To analyze the relationship between admission glucose level and clinical outcomes from acute ischemic stroke, the authors performed multivariate regression analysis with the National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator (rt-PA) Stroke Trial data. Neurologic improvement was defined as improvement on the NIH Stroke Scale by 4 or more points from baseline to 3 months, or a final score of zero. Favorable outcome was defined as both Glasgow Outcome score of 1 and Barthel Index 95 to 100 at 3 months. Symptomatic ICH was defined as CT-documented hemorrhage temporally related to clinical deterioration within 36 hours of treatment. Potential confounding factors were controlled, including acute treatment (rt-PA or placebo), age, baseline NIH Stroke Scale score, history of diabetes mellitus, stroke subtype, and admission blood pressure. Results: There were 624 patients enrolled within 3 hours after stroke onset. As admission glucose increased, the odds for neurologic improvement decreased (odds ratio [OR] = 0.76 per 100 mg/dL increase in admission glucose, 95% CI 0.61 to 0.95, p = 0.01). The relation between admission glucose and favorable outcome depended on admission mean blood pressure (MBP): as admission MBP increased, the odds for favorable outcome related to increasing admission glucose levels progressively decreased (p = 0.02). As admission glucose increased, the odds for symptomatic ICH also increased (OR = 1.75 per 100 mg/dL increase in admission glucose, 95% CI 1.11 to 2.78, p = 0.02). Admission glucose level was not associated with altered effectiveness of rt-PA. Conclusions: In patients with acute ischemic stroke, higher admission glucose levels are associated with significantly lower odds for desirable clinical outcomes and significantly higher odds for symptomatic ICH, regardless of rt-PA treatment. Whether this represents a cause and effect relationship remains to be determined.