Hyperglycemia in acute stroke
Hyperglycemia in acute stroke
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DOI：
10.1161/01.str.0000115297.92132.84
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发表时间：
2004-02-01
期刊：
影响因子：
8.3
通讯作者：
Roine, RO
中科院分区：
文献类型：
--
作者：
Lindsberg, PJ;Roine, RO
在几项溶栓试验中，高血糖被发现与出血事件有关16，最近在NINDS rt-PA试验的重新分析中再次得到证实。18在后一项研究中，入院血糖水平的升高与神经功能改善的风险降低独立相关(优势比[OR]为0.76/100 mg/dL入院血糖升高)，而症状性脑出血的OR为每100 mg/dL入院血糖升高1.75%(95%可信区间1.11至2.78，P0.02)。在排除脑出血患者后，这种关系较弱，这表明入院时高血糖可能部分通过出血事件发挥其危害。然而，Alvarez-Sabin等人最近的另一项研究发现，即使排除了有症状的脑出血患者，入院时血糖140 mg/dL(OR 8.4，CI 1.8至40.0)是3个月内再通患者功能预后差的唯一独立预测因素。19对于没有再通的患者，情况并非如此，这导致推测高血糖可能部分排除了rtPA和早期再通的有益效果。
In several thrombolysis trials, hyperglycemia has been found to be associated with hemorrhagic events16 and was reconfirmed recently17 as well as in a re-analysis of the NINDS rt-PA trial. 18 In the latter study, an increase of admission glucose level was independently associated with decreased odds for neurologic improvement (odds ratio [OR] 0.76 per 100-mg/dL increase in admission glucose) and the OR for symptomatic ICH was 1.75 per 100-mg/dL increase in admission glucose (95% CI 1.11 to 2.78, P 0.02). The relationship was weaker after excluding patients with ICH, suggesting that admission hyperglycemia may exert its hazards in part through hemorrhagic events. However, another recent study by Alvarez-Sabin et al found admission glucose140 mg/dL (OR 8.4, CI 1.8 to 40.0) to be the sole independent predictor of poor functional outcome at 3 months in patients with recanalization within 6 hours, even after excluding the patients with symptomatic ICH. 19 The same was not true for the patients who did not recanalize, which leads to speculation that hyperglycemia might partially preclude the beneficial effect of rtPA and early reperfusion.