Admission hyperglycemia causes infarct volume expansion in patients with ICA or MCA occlusion: association of collateral grade on conventional angiography
Admission hyperglycemia causes infarct volume expansion in patients with ICA or MCA occlusion: association of collateral grade on conventional angiography
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DOI：
10.1111/j.1468-1331.2012.03801.x
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发表时间：
2013-01-01
影响因子：
5.1
通讯作者：
Mochio, S.
中科院分区：
文献类型：
--
作者：
Shimoyama, T.;Shibazaki, K.;Mochio, S.
背景和目的：高血糖（HG）与急性缺血性脑卒中患者梗死面积扩大有关。然而，侧支循环可以维持缺血半暗区并限制梗死体积的增长。本研究的目的是确定HG与梗死体积扩张之间的关联是否依赖于侧支循环。方法：回顾性分析93例发病24 h内颈动脉或大脑中动脉闭塞的急性缺血性脑卒中患者。入院血糖值>= 140 mg/dl时诊断为HG。血管造影侧支分级0-1级为侧支循环不良，分级2-4级为侧支循环良好。入院时使用弥散加权磁共振成像测量梗死体积，7天内再次测量梗死体积。结果：在34例侧支分级差的患者中，HG组梗死面积的变化明显大于非HG组（106.0 ml vs 22.7 ml, P = 0.002）。在59例侧支循环良好的患者中，HG组梗死面积变化大于非HG组（53.3 ml vs 10.9 ml, P = 0.047）。多元回归分析显示，入院时HG （P = 0.004）、基线美国国立卫生研究院卒中量表评分（P = 0.018）和侧支循环不良（P = 0.040）与梗死面积扩大独立相关。结论：入院时无论侧支循环状况如何，HG患者梗死体积扩张更大。
Background and purpose: Hyperglycemia (HG) is associated with infarct volume expansion in acute ischaemic stroke patients. However, collateral circulation can sustain the ischaemic penumbra and limit the growth of infarct volume. The aim of this study was to determine whether the association between HG and infarct volume expansion is dependent on collateral circulation.Methods: We performed a retrospective analysis of 93 acute ischaemic stroke patients with internal carotid artery or middle cerebral artery occlusion within 24 h of onset were retrospectively studied. HG was diagnosed in patients with an admitting blood glucose value >= 140 mg/dl. Angiographic collateral grade 0-1 was designated as poor collateral circulation and grade 2-4 as good collateral circulation. Infarct volume was measured at admission and at again within 7 days using diffusion-weighted magnetic resonance images.Results: Among 34 patients with poor collateral grade, the change in infarct volume was significantly greater in the HG group than in the non-HG group (106.0 ml vs. 22.7 ml, P = 0.002). Among the 59 patients with good collateral circulation, the change in infarct volume was greater in the HG group than in the non-HG group (53.3 ml vs. 10.9 ml, P = 0.047). Multiple regression analysis indicated that admission HG (P = 0.004), baseline National Institutes of Health Stroke Scale score (P = 0.018), and poor collateral circulation (P = 0.040) were independently associated with infarct volume expansion.Conclusions: Infarct volume expansion was greater in individuals with HG on admission regardless of collateral circulation status.