Hyperglycemia, excess weight, and history of hypertension as risk factors for poor outcome and cerebral infarction after aneurysmal subarachnoid hemorrhage
Hyperglycemia, excess weight, and history of hypertension as risk factors for poor outcome and cerebral infarction after aneurysmal subarachnoid hemorrhage
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DOI：
10.3171/jns.2005.102.6.0998
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发表时间：
2005-06-01
影响因子：
4.1
通讯作者：
Kuhmonen, J
中科院分区：
文献类型：
--
作者：
Juvela, S;Siironen, J;Kuhmonen, J
Object.应激诱导的高血糖已被证明与蛛网膜下腔出血（SAH）后的不良结局相关。作者前瞻性地测试了高血糖是否独立于其他因素影响患者预后和SAH后脑梗死的发生。记录了175例出血后48小时内入院的SAH患者的既往疾病、健康习惯、药物治疗、临床状况和神经影像学变量。在入院时测量血糖水平，并在动脉瘤闭塞后的早晨测量空腹血糖值。通过进行多元逻辑回归分析，发现在SAH发作后3个月和脑梗死出现时独立预测患者预后的因素，发现入院时血糖值与患者年龄、体重指数（BMI）、高血压病史、临床状况、蛛网膜下腔或脑室内血液量、分流依赖性脑积水、预后变量、和脑梗塞的表现。当独立考虑年龄、临床状况或蛛网膜下腔、脑室内或脑内血量时，入院时的血糖值预测不良结局（每毫摩尔/升的比值比[OR]为1.24，95%置信区间[CI]为1.02-1.51）。在对蛛网膜下腔血的量、临床状况和手术期间暂时动脉闭塞的持续时间进行调整后，发现BMI是随访计算机断层扫描发现脑梗死的显著预测因子（OR为1.15/kg/m2，95%CI为1.02-1.29）。高血压（OR 3.11，95% CI 1. 11 -8.73）-而不是血浆葡萄糖（OR 1.06，95%CI 0.87-1.29）-也预测梗死的发生时，测试代替BMI。入院时的高血糖似乎与出血的严重程度无关，而超重和高血压似乎会增加SAH后脑梗死的风险。
Object. Stress-induced hyperglycemia has been shown to be associated with poor outcome after aneurysmal subarachnoid hemorrhage (SAH). The authors prospectively tested whether hyperglycemia, independent of other factors, affects patient outcomes and the occurrence of cerebral infarction after SAH.Methods. Previous diseases, health habits, medications, clinical condition, and neuroimaging variables were recorded for 175 patients with SAH who were admitted to the hospital within 48 hours after bleeding. The plasma level of glucose was measured at admission and the fasting value of glucose was measured in the morning after aneurysm occlusion. Factors found to be independently predictive of patient outcomes at 3 months after SAH onset and the appearance of cerebral infarction were tested by performing multiple logistic regression.Plasma glucose values at admission were found to be associated with patient age, body mass index (BMI), history of hypertension, clinical condition, amount of subarachnoid or intraventricular blood, shunt-dependent hydrocephalus, outcome variables, and the appearance of cerebral infarction. When considered independently of age, clinical condition, or amount of subarachnoid, intraventricular, or intracerebral blood, the plasma glucose values at admission predicted poor outcome (per millimole/liter the odds ratio [OR] was 1.24 with a 95% confidence interval [CI] of 1.02-1.51). After an adjustment was made for the amount of subarachnoid blood, the clinical condition, and the duration of temporary artery occlusion during surgery, the BMI was found to be a significant predictor (per kilogram/square meter the OR was 1.15 with a 95% CI of 1.02-1.29) for the finding of cerebral infarction on the follow-up computerized tomography scan. Hypertension (OR 3.11, 95% CI 1. 1 1-8.73)-but not plasma glucose (OR 1.06, 95% CI 0.87-1.29)-also predicted the occurrence of infarction when tested instead of the BMI.Conclusions. Independent of the severity of bleeding, hyperglycemia at admission seems to impair outcome, and excess weight and hypertension appear to elevate the risk of cerebral infarction after SAH.