Glucose-6-phosphate dehydrogenase deficiency and stroke outcomes
Glucose-6-phosphate dehydrogenase deficiency and stroke outcomes
复制标题
6-磷酸葡萄糖脱氢酶缺乏症与中风结果
DOI：
10.1212/wnl.0000000000010245
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发表时间：
2020-09-15
期刊：
影响因子：
9.9
通讯作者：
Zeng, Jinsheng
中科院分区：
文献类型：
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作者：
Ou, Zilin;Chen, Yicong;Zeng, Jinsheng
目的比较葡萄糖-6-磷酸脱氢酶（G6 PD）缺乏与非G6 PD缺乏的脑卒中患者的预后，评估G6 PD对脑卒中预后的危险性。方法本研究纳入1,251例急性缺血性脑卒中患者。根据入院时的G6 PD活性，将患者单独分为G6 PD缺陷组和非G6 PD缺陷组。主要终点为3个月时不良结局，定义为改良兰金量表（mRS）评分≥2（包括残疾和死亡）。次要结局包括3个月时的总体mRS评分和3个月内的院内死亡和所有死亡。Logistic回归和考克斯模型，调整潜在的混杂因素，拟合估计与G6 PD缺乏症的结果。结果1,251例患者中，G6 PD缺陷150例（12.0%）。与非G6 PD缺陷组相比，G6 PD缺陷组患者发生大动脉粥样硬化（比值比[OR] 1.53，95%置信区间[CI] 1.09-2.17）和卒中史（OR 1.93，95% CI 1.26-2.90）的比例更高。两组在总体mRS评分分布方面存在显著差异（调整后的共同OR 1.57，95% CI 1.14-2.17）。G6 PD缺乏症患者3个月时不良结局发生率较高（校正OR 1.73，95% CI 1.08-2.76;校正绝对风险增加13.0%，95% CI 2.4%-23.6%）。G6 PD缺乏症患者的院内死亡风险比为1.46（95%CI 1.37-1.84）。结论G6 PD缺乏与缺血性卒中后3个月预后不良的风险相关，并可能增加住院死亡的风险。提示脑卒中患者G6 PD筛查的合理性。
Objective To assess the risk of glucose-6-phosphate dehydrogenase (G6PD) on stroke prognosis, we compared outcomes between patients with stroke with and without G6PD deficiency. Methods The study recruited 1,251 patients with acute ischemic stroke. Patients were individually categorized into G6PD-deficiency and non-G6PD-deficiency groups according to G6PD activity upon admission. The primary endpoint was poor outcome at 3 months defined by a modified Rankin Scale (mRS) score ≥2 (including disability and death). Secondary outcomes included the overall mRS score at 3 months and in-hospital death and all death within 3 months. Logistic regression and Cox models, adjusted for potential confounders, were fitted to estimate the association of G6PD deficiency with the outcomes. Results Among 1,251 patients, 150 (12.0%) were G6PD-deficient. Patients with G6PD deficiency had higher proportions of large-artery atherosclerosis (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.09–2.17) and stroke history (OR 1.93, 95% CI 1.26–2.90) compared to the non-G6PD-deficient group. The 2 groups differed significantly in the overall mRS score distribution (adjusted common OR 1.57, 95% CI 1.14–2.17). Patients with G6PD deficiency had higher rates of poor outcome at 3 months (adjusted OR 1.73, 95% CI 1.08–2.76; adjusted absolute risk increase 13.0%, 95% CI 2.4%–23.6%). The hazard ratio of in-hospital death for patients with G6PD-deficiency was 1.46 (95% CI 1.37–1.84). Conclusions G6PD deficiency is associated with the risk of poor outcome at 3 months after ischemic stroke and may increase the risk of in-hospital death. These findings suggest the rationality of G6PD screening in patients with stroke.