Effects of admission hyperglycemia on stroke outcome in reperfused tissue plasminogen activator-treated patients
Effects of admission hyperglycemia on stroke outcome in reperfused tissue plasminogen activator-treated patients
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DOI：
10.1161/01.str.0000068406.30514.31
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发表时间：
2003-05-01
期刊：
影响因子：
8.3
通讯作者：
Quintana, M
中科院分区：
文献类型：
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作者：
Alvarez-Sabín, J;Molina, CA;Quintana, M
背景和目的-我们试图研究再灌注前高血糖对静脉注射组织型纤溶酶原激活剂（tPA）治疗的患者长期预后的影响。方法-在268例连续的非腔隙性大脑中动脉（MCA）卒中患者中，评估140 mg/dL。在基线和24小时获得美国国立卫生研究院卒中量表（NIHSS）评分。在最初24小时内进行经颅多普勒监测再通和再闭塞。在第5至7天在CT上测量总梗死体积。3个月时采用改良兰金量表评估结果。结果-NIHSS评分中位数为17。基线时，31例患者（42.5%）血糖升高，42例患者（57.5%）血糖正常。早期再灌注（140 mg/dL）（P=0.002）和早期再闭塞（P=0.004）是再灌注患者预后不良的相关因素。logistic回归模型显示，尽管tPA诱导了再通，但仅入院时血糖值>140 mg/dL（比值比，8.4; 95% CI，1.76 - 40.02; P=0.005）是不良结局的独立预测因素。在6小时持续性MCA闭塞的患者中，基线NIHSS评分>15分（P=0.011）和近端MCA闭塞（P=0.039）是单变量分析中与不良结局相关的变量。在逻辑回归模型中，只有NIHSS评分>15分（比值比，11.9; 95% CI，1.48 ~ 97.1; P=0.032）仍然是未再灌注tPA治疗患者3个月时不良结局和功能依赖性的独立预测因子。结论-再灌注前高血压可能部分抵消早期血流恢复的有益作用，尽管tPA诱导了再通，但这在高血糖患者中转化为更差的结果。
Background and Purpose-We sought to investigate the impact of hyperglycemia before reperfusion on long-term outcome in patients treated with intravenous tissue plasminogen activator (tPA).Methods-Of 268 consecutive patients with a nonlacunar middle cerebral artery (MCA) stroke evaluated at 140 mg/dL. National Institutes of Health Stroke Scale (NIHSS) scores were obtained at baseline and 24 hours. Transcranial Doppler monitoring of recanalization and reocclusion was conducted during the first 24 hours. Total infarct volume was measured on CT at day 5 to 7. Modified Rankin Scale was used to assess outcome at 3 months.Results-Median NIHSS score was 17. At baseline, 31 patients (42.5%) were hyperglycemic and 42 (57.5%) normoglycemic. Early reperfusion (140 mg/dL (P=0.002), and early reocclusion (P=0.004) were factors associated with poor outcome among reperfused patients. A logistic regression modeling revealed that only admission glucose value >140 mg/dL (odds ratio, 8.4; 95% CI, 1.76 to 40.02; P=0.005) emerged as an independent predictor of poor outcome despite tPA-induced recanalization. In patients with 6-hour persistent MCA occlusion, baseline NIHSS score >15 points (P=0.011) and proximal MCA occlusion (P=0.039) were variables associated with poor outcome on univariate analysis. In a logistic regression model, only NIHSS score >15 points (odds ratio, 11.9; 95% CI, 1.48 to 97.1; P=0.032) remained as an independent predictor of poor outcome and functional dependence at 3 months in nonreperfused tPA-treated patients.Conclusions-Hyperglycemia before reperfusion may in part counterbalance the beneficial effect of early restoration of blood flow, which translates into a worse outcome in hyperglycemic patients despite tPA-induced recanalization.