高龄非糖尿病急性脑梗死患者入院随机血糖水平与临床结局关系的倾向值评分  

Admission glucose with clinical outcomes in elderly non-diabetic patients with acute ischemic stroke:A propensity score matching study

作　　者：陈津津 於飞 刘晓昀[1] 谢甜甜 张艳丽 张尔艳 林先忠 耿同超 李明泉[1] CHEN Jinjin;YU Fei;LIU Xiaoyun;XIE Tiantian;ZHANG Yanli;ZHANG Eryan;LIN Xianzhong;GENG Tongchao;LI Mingquan(Department of Neurology,Taikang Xianlin Drum Tower Hospital,Nanjing University School of Medicine,Nanjing 210000;Department of Internal Medicine,Longpan Clinic of Nanjign General Hospital of PLA,Nanjing 210000,China)

机构地区：[1]南京大学医学院附属泰康仙林鼓楼医院神经内科,南京210000 [2]解放军南京总医院龙蟠中路门诊部内科,南京210000

出　　处：《临床与病理杂志》2020年第1期90-95,共6页Journal of Clinical and Pathological Research

基　　金：国家自然科学基金(81771424);南京大学医学院附属泰康仙林鼓楼医院科研基金项目(TKKY2611)~~

摘　　要：目的:探讨入院随机血糖水平与高龄急性脑梗死非糖尿病患者临床结局的关系。方法:连续性纳入2013年1月至2016年6月在南京大学医学院附属泰康仙林鼓楼医院与解放军南京总医院老年医学中心住院治疗年龄≥80岁的急性脑梗死非糖尿病患者。收集患者的临床资料。分别以临床结局(住院期间的病死率)和入院血糖水平为区组和干预变量,采用倾向值评分重新抽取组间协变量匹配的配对样本,并评估入院血糖水平对临床结局的影响。结果:根据临床结局,将患者分为生存组459例,死亡组294例。与生存组比较,死亡组既往卒中史显著降低,而高脂血症、贫血、高血压病、卒中后感染比例及NIHSS评分、C反应蛋白水平与住院时间显著升高(P<0.05);两组间血糖水平差异无统计学意义(P=0.11)。多因素logistic回归分析显示:血糖水平与临床结局无相关性,但NIHSS评分、高血压病史、贫血及卒中后感染是死亡的危险因素(均P<0.05)。倾向值评分匹配分组后结果显示随机血糖水平两组间差异无统计学意义(P=0.48)。结论:急性脑梗死非糖尿病患者入院血糖水平可能并不增加住院死亡风险。Objective:To investigate the influence of admission hyperglycemia on the clinical outcome in elderly non-diabetic patients with acute ischemic stroke.Methods:We consecutively collected age older than 80 years non-diabetic patients who were diagnosed as acute ischemic from January 2013 to June 2016.We evaluated the correlation between hyperglycemia and clinical outcome after resampling by propensity score matching analysis,with clinical outcome(mortality during hospitalization) as a block variable and admission glucose level as treatment variable,respectively.Results:There were 459 patients were survived(a survival group) and 294 patients died(a death group) during hospitalization.Compared with the survival group,the proportion of history of stroke was lower significantly in the death group;whereas the proportion of hyperlipidemia,anemia,hypertension,post-stroke infection,NIHSS,length of stay,C-reactive protein were higher in the death group.We failed to demonstrate different glucose level significantly between the 2 groups(P=0.11).There was no correlation between glucose level and clinical outcome after adjusted by multiple variables.Meanwhile,NIHSS,history of hypertension,anemia and poststroke infection were independent risk factors for mortality(P<0.05).We failed found glucose levels different significantly between the survival group and the death group after propensity score matching(P=0.48).Conclusion:In nondiabetic acute ischemic stroke patients,admission hyperglycemia may not increase the risk of hospitalization death.

关 键 词：急性脑梗死 高血糖 倾向值评分 临床结局 

分 类 号：R743.3[医药卫生—神经病学与精神病学]