急性脑梗死患者急性期持续高血糖对预后的影响

目的动态观察急性脑梗死患者发病3 d内的血糖变化,了解血糖情况与脑卒中预后的相关性。方法选择发病≤12 h,经头颅MRI证实的首发或再发的急性脑梗死患者1 67例,其中糖尿病患者56例(糖尿病组),非糖尿病患者111例(非糖尿病组)。糖尿病组和非糖尿病组患者分别根据血糖正常、基线高血糖、平均高血糖、持续高血糖4个不同血糖水平进行比较,评估各项危险因素,动态观察入院时及发病3 d内的血糖情况,发病30 d以改良的Rankin残障量表(mRS)评估预后。结果与非糖尿病组比较,糖尿病组患者mRS评分明显降低。与血糖正常患者比较,糖尿病组和非糖尿病组平均高血糖和持续高血糖患者预后良好率明显降低,差异有统计学意义(P0.05,P0.01)。logistic回归分析显示,急性脑梗死的预后与基线美国国立卫生研究院卒中量表、是否发生合并症及血糖情况相关。结论脑卒中后持续高血糖预示着脑卒中预后不良,脑卒中后的血糖水平是动态变化的,与单个血糖值比较,持续血糖变化情况能够更充分的预测脑卒中的预后。

Effect of persistent hyperglycemia on acute ischemic stroke outcome

Objective To analyze the dynamics of blood glucose levels within the first 3 days after acute cerebral infarction and its impact on stroke outcome.Methods A total of 167 first or recurrent ischemic stroke patients within 12 hours of stroke onset,who were confirmed by MRI,were studied.Of them,56 were diabetic patients(diabetic group),and 111 nondiabetic patients(nondiabetic group).Serum glucose was measured on admission and every day within first 3 days.According to level of serum glucose,each group was divided into four subgroups,normoglycemia,hyperglycemia at baseline,mean hyperglycemia,and persistent hyperglycemia.Risk factors were analyzed. 30-day stroke outcome was assessed with the mRS score.Results MRS scores were significantly lower in diabetic group than in nondiabetic group.Compared with normoglycemia subgroup, the rate of good prognosis was lower in both mean hyperglycemia subgroup and persistent hyperglycemia subgroup,no matter with or without diabetes before.The difference had statistical significance (P< 0.05,P < 0.01).The result of logistic regression analysis indicated that the prognosis of acute cerebral infarction was associated with baseline NIHSS,complications and persistent hyperglycemia.Conclusion Poststroke persistent hyperglycemia is associated with a poor clinical outcome.Glycemia after stroke has dynamic changes.Compared with a single glucose measurement,the dynamic glucose level is a better predictor of ischemic stroke outcome.