不同血糖指标对老年急性中重度缺血性脑卒中患者静脉溶栓结局的影响  

Effects of glucose parameters on outcome of intravenous thrombolysis in elderly patients with moderate to severe acute ischemic stroke

作　　者：魏妙妙 薛娟娟[1] 路蔚[1] 夏晓爽[1] 王林[2] 李新[1] Wei Miaomiao;Xue Juanjuan;Lu Wei;Xia Xiaoshuang;Wang Lin;Li Xin(Department of Neurology,Tianjin Medical University Second Hospital,Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院神经内科,300211 [2]天津医科大学第二医院保健医疗部/老年病科,300211

出　　处：《中华老年心脑血管病杂志》2022年第8期845-848,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：天津市科技计划项目(18ZXDBSY00210);中国脑卒中高危人群干预适宜技术研究及推广项目(GN-2020R0005)。

摘　　要：目的观察不同血糖指标对老年急性中重度缺血性脑卒中(AIS)患者静脉溶栓结局的影响。方法纳入2018年1月~2021年12月于天津医科大学第二医院神经内科或老年病科接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的年龄≥65岁中重度AIS患者205例,采集血糖指标。静脉溶栓后24 h症状性脑出血(sICH)15例,早期神经功能改善(ENI)78例。90 d预后良好111例,预后不良94例。分析不同血糖指标对溶栓结局的影响。结果sICH患者糖化血红蛋白(HbA1c)水平明显高于无sICH患者(P<0.05)。ENI患者溶栓前随机血糖,空腹血糖,HbA1c水平明显低于无ENI患者(P<0.05,P<0.01)。14 d预后良好患者溶栓前随机血糖,空腹血糖,HbA1c水平明显低于14 d预后不良患者(P<0.05,P<0.01)。90 d预后良好患者空腹血糖,HbA1c水平明显低于90 d预后不良患者(P<0.01)。空腹血糖水平是ENI(95%CI:0.345~0.940)、14 d预后不良(95%CI:1.086~6.462)及90 d预后不良(95%CI:1.171~4.688)的独立影响因素(P<0.05),HbA1c是90 d预后不良的独立影响因素(95%CI:1.413~5.961,P=0.020)。结论空腹血糖和HbA1c水平是老年急性中重度AIS静脉溶栓治疗不同结局的独立影响因素。Objective To determine the effects of different glucose parameters on outcome of IVT in elderly patients with moderate to severe AIS.Methods A total of 205 patients aged≥65 years with moderate to severe AIS,who received IVT treatment with rt-PA in the department of neurology or geriatrics of our hospital from January 2018 to December 2021,were enrolled retrospectively.Glucose parameters were collected.In 24 h after IVT,there were 15 patients with sICH and 78 patients with ENI.In 90 d,111 patients had good prognosis,and 94 patients had poor prognosis.The effects of different glucose parameters on outcome of IVT were determined.Results HbA1c level was higher in the patients with sICH than those without(P<0.05).RBG,FPG and HbA1c levels were decreased in the patients with ENI than those without ENI(P<0.05,P<0.01).In 14 d,lower RBG,FPG and HbA1c levels were found in patients with good outcome than those without(P<0.05,P<0.01),and lower FPG and HbA1c levels were also seen in those with good outcome at 90 days(P<0.01).FPG was independent influencing factor for ENI(95%CI:0.345-0.940)and poor outcomes at 14 days(95%CI:1.086-6.462)and 90 days(95%CI:1.171-4.688,P<0.05).While HbA1c was also an independent influencing factor for poor outcome at 90 days(95%CI:1.413-5.961,P=0.020).Conclusion FPG and HbA1c are independent predictors for outcome after IVT in elderly patients with moderate to severe AIS.

关 键 词：血糖指数 卒中 组织型纤溶酶原激活物 脑出血 

分 类 号：R743.3[医药卫生—神经病学与精神病学]