Glycosylated Hemoglobin and Functional Outcome after Acute Ischemic Stroke
Glycosylated Hemoglobin and Functional Outcome after Acute Ischemic Stroke
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DOI：
10.1016/j.jstrokecerebrovasdis.2016.03.018
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发表时间：
2016-07-01
影响因子：
2.5
通讯作者：
Silvestrini, Mauro
中科院分区：
文献类型：
--
作者：
Lattanzi, Simona;Bartolini, Marco;Silvestrini, Mauro
背景资料：糖尿病（DM）与脑梗死和心肌梗死的发生率增加相关，长期维持最佳血糖值可降低脑梗死和心肌梗死的发生率。本研究的目的是评估糖尿病合并缺血性卒中患者的慢性血糖状态及其与功能结局的关系。方法：我们回顾性地确定了因急性缺血性卒中住院的连续糖尿病患者。入院时评估临床和生化特征。根据改良兰金量表评分，结果指标为达到推荐的糖化血红蛋白A1（HbA1c）水平和3个月功能状态。结果：在112例入组患者中，39例（34.8%）达到HbA1c低于7%的推荐目标。较高的教育水平预测卒中前血糖控制良好（调整后OR为1.32/年[95%CI 1.15 - 1.51]，P = 7%，P = 0.002）。结论：在近三分之二的糖尿病患者中，急性缺血性卒中的DM治疗效果不佳。卒中发生前的血糖控制是一个独立的预后因素，HbA1c值高于推荐目标会增加3个月不良结局的风险。改善糖尿病管理可能是降低脑血管疾病负担或影响其临床进程的有效策略。(C)2016年全国中风协会。爱思唯尔公司出版All rights reserved.
Background: Diabetes mellitus (DM) is associated to an increased incidence of cerebral and myocardial infarction which could be reduced by long-term maintenance of optimal glycemic values. The aim of the study was to evaluate in diabetic patients with ischemic stroke the chronic glycemic status and its relationship with functional outcome. Methods: We retrospectively identified consecutive diabetic patients hospitalized for acute ischemic stroke. Clinical and biochemical characteristics at admission were assessed. The outcome measures were the attainment of the recommended glycosylated hemoglobin A1 (HbA1c) level and the 3-month functional status according to the modified Rankin Scale score. Results: Among the 112 enrolled patients, 39 (34.8%) met the recommended goal of HbA1c less than 7%. Higher education level was predictive of good prestroke glycemic control (adjusted OR 1.32 per year [95% CI 1.15-1.51], P= 7%, P=.002). Conclusions: The management of DM was suboptimal in nearly two thirds of diabetic subjects presenting with acute ischemic stroke. The glycemic control before stroke occurrence was an independent prognostic factor and HbA1c values above the recommended goals increased the risk of unfavorable 3-month outcome. The improvement of DM management may be an effective strategy to either decrease the burden of cerebrovascular disease or influence its clinical course. (C) 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.