血糖波动对动脉瘤性蛛网膜下腔出血后迟发性脑缺血及30天死亡的影响  

The Impact of Blood Glucose Fluctuation on Delayed Cerebral Ischemia and 30-day Mortality in Aneurysm Subarachnoid Hemorrhage

作　　者：吴倩 陶立元[2] 陈思琪 钟莲梅[1] 刘丽萍[3] 米东华[3] WU Qian;TAO Liyuan;CHEN Siqi;ZHONG Lianmei;LIU Liping;MI Donghua(Department of Neurology,The First Affiliated Hospital,Kunming Medical University,Kunming 650032,China;Clinical Epidemiology Research Center,Peking University Third Hospital,Beijing 100191,China;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]昆明医科大学第一附属医院神经内科,昆明650032 [2]北京大学第三医院临床流行病学研究中心 [3]首都医科大学附属北京天坛医院神经病学中心血管神经病学科

出　　处：《中国卒中杂志》2022年第8期845-850,共6页Chinese Journal of Stroke

摘　　要：目的 探讨血糖波动与动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者发生迟发性脑缺血(delayed cerebral ischemic,DCI)及30 d死亡的关系。方法 回顾性收集并分析aSAH患者的临床资料。连续收集患者14 d空腹血糖水平并按其特征分为4组:稳定组(第1天<7 mmol/L,2~14 d均<10mmol/L)、不稳定组(第1天<7 mmol/L,2~14 d至少1次≥10 mmol/L)、控制良好组(第1天≥7 mmol/L,2~14 d均<10 mmol/L)和控制不良组(第1天≥7mmol/L,2~14 d至少1次≥10 mmol/L),采用单因素和多因素分析探索血糖波动对患者发生DCI和30 d全因死亡的影响。结果 研究共纳入341例患者,其中血糖稳定组212例,不稳定组23例,控制良好组62例,控制不良组44例。单因素分析显示,4组的DCI发生率差异有统计学意义(P=0.043),其中不稳定组DCI发生率最高(39.13%),其次是控制不良组(29.55%)、稳定组(17.92%)和控制良好组(17.74%);30 d全因死亡率差异也有统计学意义(P<0.001),其中控制不良组死亡率最高(15.91%),其次是不稳定组(13.04%)、控制良好组(6.45%)和稳定组(1.42%)。多因素logistic回归分析显示,血糖控制不稳定(OR 6.032,95%CI 1.941~18.747,P=0.002)和控制不良(OR 2.889,95%CI 1.247~6.691,P=0.013)是aSAH患者发生DCI的危险因素,同时,血糖控制不稳定(OR 14.033,95%CI 1.971~99.921,P=0.008)和控制不良(OR 19.723,95%CI 3.597~108.143,P=0.001)也是aSAH患者30 d全因死亡的危险因素。结论 aSAH患者血糖控制不稳定或控制不良与DCI和30 d死亡相关。Objective To clarify the relationship of blood glucose fluctuation and delayed cerebral ischemia and 30-day mortality in aneurysmal subarachnoid hemorrhage(aSAH) patients.Methods The data of aSAH patients were collected and retrospectively analyzed.Continuous 14-day fasting blood glucose level was collected and patients were divided into four groups:stable(Day 1, <7 mmol/L;Day 2-14, all <10 mmol/L), unstable(Day 1, <7 mmol/L;Day 2-14, at least once ≥10 mmol/L), well-controlled(Day 1, ≥7 mmol/L;Day 2-14, all <10 mmol/L) and bad-controlled(Day 1, ≥7 mmol/L;Day 2-14, at least once ≥10 mmol/L).Univariate and multivariate analysis were used to analyze the impact of glucose fluctuation on delayed cerebral ischemia and 30-day all-cause mortality.Results A total of 341 patients were included, with 212 cases in stable group, 23 in unstable group, 62 in well-controlled group and 44 in bad-controlled group.The incidence of delayed cerebral ischemia among the four groups as follows:the highest incidence was 39.13% in unstable group, then 29.55% in bad-controlled group, 17.92% in stable group and the lowest was 17.74% in wellcontrolled group, with statistical difference(P=0.043).30-day all-cause mortality as follows:the highest mortality was 15.91% in bad-controlled group, then 13.04% in unstable group, 6.45% was in well-controlled group, and the lowest was 1.42% in stable group, with statistical difference(P<0.001).Logistic regression analysis showed that unstable and bad-controlled blood glucose were risk factors of delayed cerebral ischemia occurrence(OR 6.032, 95%CI 1.941-18.747, P=0.002;OR 2.889, 95%CI 1.247-6.691, P =0.013) and 30-day all-cause mortality(OR 14.033, 95%CI 1.971-99.921, P =0.008;OR 19.723, 95%CI 3.597-108.143, P =0.001) in aSAH patients.Conclusions The unstable and bad-controlled blood glucose levels in aSAH patients were associated with delayed cerebral ischemia and 30-day mortality.

关 键 词：动脉瘤性蛛网膜下腔出血 血糖波动 迟发性脑缺血 死亡 预后 

分 类 号：R743.35[医药卫生—神经病学与精神病学]