自发性脑出血急性期高血糖与预后的关系

目的探讨自发性脑出血急性期血糖水平与预后的关系。方法前瞻性连续纳入2002年3月1日～2009年3月1日于四川大学华西医院神经内科入院，发病至入院并接受评价时间≤24h的急性脑出血患者。收集患者入院随机血糖以及其他与预后相关的临床资料。高血糖定义为入院随机血糖〉18mmol／L。盲法随访患者脑出血后1年的死亡、残疾（定义为改良Rankin评分≥3）的情况。采用多因素Logistic回归分析高血糖与预后的关系。结果共纳入脑出血患者661例。①661例中，高血糖患者194例（29．3％），正常血糖患者467例。糖尿病患者65例（9．8％）。②Pearson相关分析显示，入院时的美国国立卫生研究院卒中量表评分（NIHSS）与入院随机血糖水平呈显著正相关（r=0．392，P=0．000）。③与血糖正常的患者相比，高血糖患者1年死亡的风险是正常血糖患者的4．357倍（OR=4．357；95％CI：2．586—7．340），1年死亡／残疾的风险是正常血糖患者的3．117倍（OR=3．117；95％CI：1．888～5．144）。结论入院血糖水平与疾病严重程度呈显著正相关，入院随机血糖增高可能是影响自发性脑出血患者1年预后的独立因素。

Relationship between acute hyperglycemia and prognosis in patients following spontaneous intracerebral hemorrhage

Objectives To investigate the relationship between acute hyperglycemia level and progosis in patients following spontaneous intracerebral hemorrhage. Methods A total 661 consecutive patients with acute intracerebral hemorrhage （from symptom onset to hospital and evaluated ≤24 hours） were admitted to West China Hospital, Sichuan University from March 1, 2002 to March 1, 2009 were recruited prospectively. The blood glucose levels of the patients and other clinical materials related to the prognosis were collected comprehensively. Hyperglycemia was defined as the blood glucose level ≥8 mmol/L at admission. The mortality and disability（ as modified Rankin scale ≥3） of the patients 1 year after intracerebral hemorrhage were followed up. Multivariate logistic regression was used to analyze the relationship between hyperglycemia and prognosis. Results A total of 661 patients with intracerebral hemorrhage were recruited. ①Of the patients, 194 （29.3%） had hyperglycemia and 65 （9.8%） had diabetes mellitus. ②The National Institutes of Health Stroke Scale （NIHSS） score were positively correlated with the admission random blood glucose levels significantly （ r = 0. 392, P = 0. 000）. ③Compared to the patients with normal blood glucose, the risk of death in patients with hyperglycemia was 4. 357 times of those with normal blood glucose at 1 year （ OR = 4. 357 ; 95% CI： 2. 586 - 7. 340 ）, and the risks of mortality/disability was 3. 117 times of those with normal blood glucose at 1 year （ OR = 3. 117; 95% CI： 1. 888 - 5. 144）. Conclusion The blood glucose levels on admission showed significant positive correlation with the severity of the disease. The random glucose level ≥ 8 mmol/L on admission might be an independent risk factor influencing the prognosis of patients 1 year after spontaneous intracerebral hemorrhage.