空腹血糖预测重度急性缺血性卒中患者静脉溶栓治疗后转归  

Clinical ResearchFasting blood glucose predicts the outcome after intravenous thrombolytic therapy in patients with severe acute ischemic stroke

作　　者：邓柯 李画画 张欣欣 高宗恩[2] 李雪梅[1] Deng Ke;Li Huahua;Zhang Xinxin;Gao Zongen;Li Xuemei(Weifang Medical University,Weifang 261053,China;Department of Neurolog,Shengli Oilfield Central Hospital,Dongying 257034,China)

机构地区：[1]潍坊医学院,潍坊261053 [2]胜利油田中心医院神经内科,东营257034

出　　处：《国际脑血管病杂志》2021年第8期570-575,共6页International Journal of Cerebrovascular Diseases

基　　金：国家重点研究开发项目 (2016YFC1301502)。

摘　　要：目的探讨空腹血糖对重度急性缺血性卒中(acute ischemic stroke,AIS)患者静脉溶栓后临床转归的预测价值。方法回顾性连续纳入2016年1月至2020年11月在胜利油田中心医院神经内科接受静脉溶栓治疗的重度AIS患者。重度AIS定义为基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分≥15分。主要终点事件为发病后90 d时根据改良Rankin量表评价的临床转归,0~2分定义为转归良好,>2分定义为转归不良。次要终点事件为任何颅内出血和有症状颅内出血(symptomatic intracranial hemorrhage,sICH),颅内出血定义为在住院期间治疗后颅脑影像学检查显示的任何局部或远隔部位实质性出血,sICH定义为在治疗后7 d内影像学检查显示任何颅内出血且NIHSS评分增加≥4分。采用单变量和多变量logistic回归分析确定各种终点事件的独立影响因素。应用受试者工作特征曲线评估空腹血糖水平对转归事件的预测价值。结果共纳入113例接受静脉溶栓治疗的重度AIS患者,73例(64.6%)转归不良;29例(25.7%)发生颅内出血,其中10例(8.8%)为sICH。多变量分析显示,空腹血糖是患者发病后90 d时转归不良[优势比(odds ratio,OR)1.451,95%置信区间(confidence interval,CI)1.053~2.000;P=0.023]以及sICH(OR 1.235,95%CI 1.013~1.504;P=0.036)的独立危险因素。受试者工作特征曲线分析显示,空腹血糖预测发病后90 d时临床转归不良的曲线下面积为0.731(95%CI 0.637~0.824),最佳截断值为6.25 mmol/L,对应的敏感性和特异性分别为63.0%和82.5%。空腹血糖预测sICH的曲线下面积为0.728(95%CI 0.577~0.878),最佳截断值为7.98 mmol/L,对应的敏感性和特异性分别为70.0%和77.7%。结论空腹血糖是接受静脉溶栓治疗的重度AIS患者发病后90 d时转归不良和sICH的独立预测因素。Objective To investigate the predictive value of fasting blood glucose on clinical outcome after intravenous thrombolysis in patients with severe acute ischemic stroke(AIS).Methods From January 2016 to November 2020,consecutive patients with severe AIS receiving intravenous thrombolysis in the Department of Neurology,Shengli Oilfield Central Hospital were enrolled retrospectively.Severe AIS was defined as the baseline National Institutes of Health Stroke Scale(NIHSS)score≥15.The primary endpoint was the clinical outcome evaluated according to the modified Rankin Scale at 90 d after onset.0-2 was defined as a good outcome and a score of>2 were defined as a poor outcome.The secondary endpoint events were any intracranial hemorrhage and symptomatic intracranial hemorrhage(sICH).Intracranial hemorrhage was defined as any local or distant parenchymal hemorrhage shown by craniocerebral imaging during the hospitalization.sICH was defined as any intracranial hemorrhage and the NIHSS score increased by≥4 within 7 d after treatment.Univariate and multivariate logistic regression analysis were used to determine the independent influencing factors of various endpoint events.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of fasting blood glucose levels for endpoint events.Results A total of 113 patients with severe AIS treated with intravenous thrombolysis were included,and 73(64.6%)had a poor outcome;29(25.7%)had intracranial hemorrhage,of which 10(8.8%)were sICH.Multivariate analysis showed that fasting blood glucose was the independent risk factors for poor outcome(odds ratio[OR]1.451,95%confidence interval[CI]1.053-2.000;P=0.023)and sICH(OR 1.235,95%CI 1.013-1.504;P=0.036).The ROC curve analysis showed that the area under the curve of fasting blood glucose predicting poor clinical outcome at 90 d after onset was 0.731(95%CI 0.637-0.824),the optimal cut-off value was 6.25 mmol/L,and the corresponding sensitivity and specificity were 63.0%and 82.5%respectively.The area under th

关 键 词：卒中 脑缺血 疾病严重程度指数 血栓溶解疗法 血糖 治疗结果 危险因素 试验预期值 

分 类 号：R743.3[医药卫生—神经病学与精神病学]