Impact of Metformin on the Severity and Outcomes of Acute Ischemic Stroke in Patients with Type 2 Diabetes Mellitus
Impact of Metformin on the Severity and Outcomes of Acute Ischemic Stroke in Patients with Type 2 Diabetes Mellitus
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DOI：
10.1016/j.jstrokecerebrovasdis.2015.10.016
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发表时间：
2016-02-01
影响因子：
2.5
通讯作者：
Okada, Yasushi
中科院分区：
文献类型：
--
作者：
Mima, Yohei;Kuwashiro, Takahiro;Okada, Yasushi
背景：糖尿病(DM)是心血管疾病的主要危险因素。据报道，二甲双胍治疗降低了中风的风险，但临床研究中尚未调查二甲双胍治疗与神经严重程度或患者预后之间的关系。这项研究评估了二甲双胍对2型糖尿病急性缺血性卒中患者卒中严重程度和预后的影响。方法：研究对象为2010年4月至2014年9月在九州医学中心就诊的355例无严重肾损害或卒中前日常生活能力障碍的2型糖尿病患者。入院时根据美国国立卫生研究院卒中评分(NIHSS)评估神经严重程度。轻度神经严重程度定义为入院时NIHSS评分低于3分，良好功能结果定义为出院时改良Rankin量表评分为2或更低。结果：在调整多个混杂因素的Logistic回归分析中，二甲双胍治疗与轻度神经症状独立相关(优势比[OR]，2.12；95%可信区间[CI]，1.09~4.10；P=.026)。相比之下，功能结果显示没有显著的相关性。然而，既往有中风病史的患者(OR，11.3；P=.046)和排除轻度中风病史的患者(OR，5.64；P=.042)均可观察到先前使用二甲双胍的益处。结论：糖尿病患者在卒中发作前应用二甲双胍可能与降低神经严重程度和改善急性期治疗结果有关。
Background: Diabetes mellitus (DM) is a major risk factor for cardiovascular disease. Metformin therapy reportedly decreases the risk of stroke, but the associations between metformin treatment and neurological severity or patient prognosis have not been investigated in clinical studies. This study evaluated the effects of metformin on stroke severity and outcomes in acute ischemic stroke patients with type 2 DM. Methods: We examined 355 stroke patients with type 2 DM without severe renal impairment or prestroke impairment of activities of daily living who were admitted to Kyushu Medical Center between April 2010 and September 2014. Neurological severity was assessed according to the National Institutes of Health Stroke Scale (NIHSS) score on admission. Mild neurological severity was defined as an NIHSS score lower than 3 on admission, and favorable functional outcome was defined as a modified Rankin Scale score of 2 or lower at discharge. Results: On logistic regression analysis with adjustments for multiple confounding factors, pretreatment with metformin was independently associated with mild neurological symptoms (odds ratio [OR], 2.12; 95% confidence interval [CI], 1.09- 4.10; P=.026). In contrast, functional outcomes showed no significant associations. Nevertheless, a benefit of prior metformin use was observed in patients with a prior history of stroke (OR, 11.3; P=.046) and in patients after excluding those with mild stroke severity (OR, 5.64; P=.042). Conclusions: Administration of metformin in DM patients prior to stroke onset may be associated with reduced neurological severity and improved acute-phase therapy outcomes.