Acute hyperglycemia adversely affects stroke outcome: A magnetic resonance imaging and spectroscopy study
Acute hyperglycemia adversely affects stroke outcome: A magnetic resonance imaging and spectroscopy study
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DOI：
10.1002/ana.10241
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发表时间：
2002-07-01
影响因子：
11.2
通讯作者：
Davis, SM
中科院分区：
文献类型：
--
作者：
Parsons, MW;Barber, PA;Davis, SM
急性高血糖是否与更严重的脑卒中预后有因果关系或仅仅反映更严重的脑卒中存在争议。在可逆性缺血模型中，高血糖与乳酸酸中毒和半暗组织向梗死的转化有关。然而，高血糖、乳酸性酸中毒和脑卒中结局之间的关系尚未在人类中得到探讨。对63例急性脑卒中患者进行前瞻性评估，采用扩散加权和灌注加权磁共振成像和急性血糖测量。低灌注危险组织患者通过急性灌注-扩散病变不匹配来识别。作为一项亚研究，对33例最近的患者进行急性和亚急性磁共振波谱检查，以评估缺血区域急性血糖和乳酸生成之间的关系。在63例急性灌注-扩散失配患者中的40例中，急性高血糖与梗死后失配组织残余物减少、最终梗死面积增大和功能预后恶化相关。这些相关性与基线中风严重程度、病变大小和糖尿病状态无关。此外，灌注-扩散失配患者急性血糖升高与急性-亚急性乳酸生成增加相关，而后者又与失配组织的挽救减少独立相关。相反，非配错患者的急性血糖水平与结果测量没有独立的相关性，该组中也没有任何急性-亚急性乳酸升高。急性高血糖增加脑乳酸生成，促进低灌注危险组织转化为梗死，这可能对卒中结局产生不利影响。这些发现支持了在急性卒中中积极控制血糖的随机对照试验的必要性。
Controversy exists whether acute hyperglycemia is causally associated with worse stroke outcome or simply reflects a more severe stroke. In reversible ischemia models, hyperglycemia is associated with lactic acidosis and conversion of penumbral tissue to infarction. However, the relationship between hyperglycemia, lactic acidosis, and stroke outcome has not been explored in humans. Sixty-three acute stroke patients were prospectively evaluated with serial diffusion-weighted and perfusion-weighted magnetic resonance imaging and acute blood glucose measurements. Patients with hypoperfused at-risk tissue were identified by acute perfusion-diffusion lesion mismatch. As a substudy, acute and subacute magnetic resonance spectroscopy was performed in the 33 most recent patients to assess the relationship between acute blood glucose and lactate production in the ischemic region. In 40 of 63 patients with acute perfusion-diffusion mismatch, acute hyperglycemia was correlated with reduced salvage of mismatch tissue from infarction, greater final infarct size, and worse functional outcome. These correlations were independent of baseline stroke severity, lesion size, and diabetic status. Furthermore, higher acute blood glucose in patients with perfusion-diffusion mismatch was associated with greater acute-subacute lactate production, which, in turn, was independently associated with reduced salvage of mismatch tissue. In contrast, acute blood glucose levels in nonmismatch patients did not independently correlate with outcome measures, nor was there any acute-subacute increase in lactate in this group. Acute hyperglycemia increases brain lactate production and facilitates conversion of hypoperfused at-risk tissue into infarction, which may adversely affect stroke outcome. These findings support the need for randomized controlled trials of aggressive glycemic control in acute stroke.