Chronic hyperglycemia is related to poor functional outcome after acute ischemic stroke
Chronic hyperglycemia is related to poor functional outcome after acute ischemic stroke
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DOI：
10.1177/1747493016676619
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发表时间：
2017-02-01
影响因子：
6.7
通讯作者：
Biessels, Geert Jan
中科院分区：
文献类型：
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作者：
Luitse, Merel J. A.;Velthuis, Birgitta K.;Biessels, Geert Jan
背景急性高血糖与缺血性卒中后不良功能结局相关，但慢性前驱高血糖与结局之间的关系尚不清楚。Aim我们评估了通过血红蛋白A1 c测定的慢性高血糖与急性缺血性卒中患者功能结局之间的关系。患者按血红蛋白A1 c水平分类：无（42 mmol/mol）。3个月后改良兰金量表评分>2分为功能预后差。慢性高血糖与功能预后的关系采用Poisson回归分析，以无慢性高血糖患者为参照，以危险比（95%可信区间）表示。结果慢性高血糖患者中中度高血糖234例（28.8%），重度高血糖183例（22.5%）。入院时急性高血糖338例（41.6%）。重度慢性高血糖与不良结局相关（风险比1.40; 95%置信区间1.09-1.79）。校正年龄、性别、卒中严重程度、血管危险因素和入院时急性高血糖后，风险比为1.35（95%置信区间1.04-1.76）。中度慢性高血糖与不良预后无关（危险比1.12，95%可信区间0.87-1.44）。这种关联与卒中急性期的高血糖和不利的血管危险因素无关。
Background Acute hyperglycemia is associated with poor functional outcome after ischemic stroke, but the association between chronic antecedent hyperglycemia and outcome is unclear.Aim We assessed the association between chronic hyperglycemia, measured by hemoglobin A1c, and functional outcome in patients with acute ischemic stroke.Methods We included 812 patients with acute ischemic stroke (mean age 6614 years; 61.5% male). Patients were categorized per hemoglobin A1c level: no (42mmol/mol). Poor functional outcome was defined as modified Rankin Scale score>2 after 3 months. The relation between chronic hyperglycemia and functional outcome was assessed with a Poisson regression analysis and expressed as risk ratios with 95% confidence intervals with no chronic hyperglycemia as the reference.Results Moderate chronic hyperglycemia was present in 234 (28.8%) patients and severe chronic hyperglycemia in 183 (22.5%) patients. Acute hyperglycemia on admission was present in 338 (41.6%) patients. Severe chronic hyperglycemia was associated with poor outcome (risk ratios 1.40; 95% confidence interval 1.09-1.79). After adjustment for age, sex, stroke severity, vascular risk factors, and acute hyperglycemia on admission the risk ratios was 1.35 (95% confidence interval 1.04-1.76). Moderate chronic hyperglycemia was not associated with poor outcome (risk ratios 1.12; 95% confidence interval 0.87-1.44).Conclusion Severe chronic hyperglycemia is associated with poor functional outcome in patients with acute ischemic stroke. This association is independent of hyperglycemia in the acute stage of stroke and of an unfavorable vascular risk factor profile.