The role of hyperglycemia in acute stroke
The role of hyperglycemia in acute stroke
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DOI：
10.1001/archneur.58.8.1209
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发表时间：
2001-08-01
影响因子：
--
通讯作者：
Knobler, H
中科院分区：
文献类型：
--
作者：
Kagansky, N;Levy, S;Knobler, H
背景：缺血性脑卒中是导致死亡和长期残疾的主要原因，高血糖被认为会加重脑缺血。目的：综述高血糖与脑缺血关系的动物和人类研究，阐明高血糖有害作用的一些机制。讨论当前和未来血糖控制的临床建议。方法：检索1976年至2000年的计算机数据来源和已发表的索引和文章，以评估卒中和高血糖之间的关系，以及对局灶性和全局性脑缺血的高血糖动物的实验模型的研究。结果：大多数人类研究表明，在急性卒中中，伴有或不伴有糖尿病的患者入院时高血糖与无高血糖患者的临床预后相关。这种关联在非腔隙性卒中中更为一致。动物研究支持这些发现，在全局和局灶性缺血后模型中均显示，高血糖会加剧以下损害过程：细胞内酸中毒、细胞外谷氨酸积累、脑水肿形成、血脑屏障破坏和出血转化倾向。研究发现，胰岛素治疗高血糖动物对局灶性和全局性脑缺血有有益的作用，这可能是通过葡萄糖降低作用或直接的神经保护作用介导的。结论：大多数研究显示早期高血糖的有害作用，特别是对非腔隙局灶性或全身性缺血的患者。强化胰岛素治疗的临床试验是必要的。同时，建议采取简单的措施避免过度高血糖。
Background: Ischemic stroke is a leading cause of death and long-term disability, and hyperglycemia is believed to aggravate cerebral ischemia.Objectives: To review animal and human studies on the relationship between hyperglycemia and brain ischemia that elucidate some of the mechanisms for the deleterious effect of hyperglycemia. To discuss present and future clinical recommendations for glucose control.Methods: Computerized data sources and published indexes and articles from 1976 through 2000 were searched for human studies that evaluated the association between stroke and hyperglycemia, and studies focused on experimental models of hyperglycemic animals with focal and global brain ischemia.Results: Most human studies have shown that in acute stroke, admission hyperglycemia in patients with or without diabetes is associated with a worse clinical outcome than in patients without hyperglycemia. This association is more consistent in the nonlacunar type of stroke. Animal studies support these findings by showing both in global and in focal postischemic models that hyperglycemia exaggerates the following damaging processes: intracellular acidosis, accumulation of extracellular glutamate, brain edema formation, blood-brain barrier disruption, and tendency for hemorrhagic transformation. Insulin treatment of hyperglycemic animals was found to have a beneficial effect in focal and global brain ischemia, which may be mediated by the glucose-reduction effect or by a direct neuroprotection.Conclusions: Most studies show the deleterious effect of early hyperglycemia, especially in patients with nonlacunar focal or global ischemia. Clinical trials of intensive insulin treatment are needed. Meanwhile simple measures to avoid excessive hyperglycemia are recommended.