入院血糖水平与急性缺血性脑卒中患者出院残疾、死亡和复合结局的关联

目的探讨入院时血糖水平与急性缺血性脑卒中患者出院残疾、死亡和复合结局的关联。方法采用回顾性队列研究的方法,连续性纳入2009年6月1日至2012年5月31日阜新市中心医院3 151例急性缺血性脑卒中患者,收集人口统计学、生活方式、入院时血糖水平等实验室检查结果。出院时脑卒中量表mRS≥3分为残疾,mRS≥3或死亡为复合结局。根据入院时血糖水平(<6.1mmol/L,6.1⁶.9 mmol/L,≥7.0 mmol/L)水平将研究对象分为3组,采用Cox比例风险回归模型分析入院时血糖水平与急性缺血性脑卒中患者出院残疾、死亡和复合结局的关联。结果残疾组和死亡组的入院血糖水平和血糖升高率均高于对照组,差异有统计学意义(P<0.05);经多因素校正后,以第1组为参比,第3组增加了急性缺血性脑卒患者发生残疾、死亡和复合结局的风险,HR值和95%CI分别为1.58(1.286.9 mmol/L,≥7.0 mmol/L)水平将研究对象分为3组,采用Cox比例风险回归模型分析入院时血糖水平与急性缺血性脑卒中患者出院残疾、死亡和复合结局的关联。结果残疾组和死亡组的入院血糖水平和血糖升高率均高于对照组,差异有统计学意义(P<0.05);经多因素校正后,以第1组为参比,第3组增加了急性缺血性脑卒患者发生残疾、死亡和复合结局的风险,HR值和95%CI分别为1.58(1.28¹.96)、4.13(2.541.96)、4.13(2.54⁶.70)和1.89(1.566.70)和1.89(1.56².29)并且随着血糖水平的增加急性缺血性脑卒患者发生残疾、死亡和复合结局的风险也增加(趋势性检验P<0.001)。结论急性缺血性脑卒中患者入院时血糖水平升高增加了出院残疾、死亡和复合结局发生的风险,并存在剂量反应关系。

Association between blood glucose and the risk of disability,death and composite outcome

Objective To explore association between serum albumin and the risk of disability,death and composite outcome among patients with acute ischemic stroke,so as to inprove the outcomes.Methods We conducted a retrospective cohort study from June 1,2009 to May 31,2011,continuously included 3 151 patients with acute ischemic stroke.Blood glucose was measured at the time of admission.Functional outcome was measured with the modified Rankin scale （mRS） when subjects were discharged.Disability was defined as mRS ≥ 3 and composite outcome was defined as mRS ≥3 or death.Blood glucose was divided into three groups according to ＜6.1mmol/L,6.1～6.9 mmol/L,≥7.0 mmol/L.Multiple Cox regression analysis was used to assess the independent association between blood glucose and disability,death and composite outcome.Results The levels of blood glucose and the rates of hyperglycemia in groups of disability and death were both higer than that of control （P＜0.05）.Compaired with the lowest group of blood glucose,the risks of disability,death and composite outcome with blood glucose in the third group were higher,HR and 95％CI were 1.58 （1.28～1.96,4.13 （2.54～6.70）,1.89 （1.56～2.29） respectively after adjusting for potential confounding factors.There was dose-response relationship between blood glucose and risks of disability,death and composite outcome （trend P＜0.01）.Conclusion Elevated blood glucose increased the risks of disability,death and composite outcome.The lower blood glucose was the higher risks of disability,death and composite outcome might be.