血糖变异性对缺血性脑卒中行溶栓人群的预测价值  

The predictive value of glycemic variability in ischemic stroke patients undergoing thrombolytic therapy

作　　者：汪玲娥 张东平[1] 丁查文 陈中美[1] 郑磊[1] WANG Linge;ZHANG Dongping;DING Chawen;CHEN Zhongmei;ZHENG Lei(Department of Neuroscience,Chong Gang General Hospital,Chongqing 400080,China)

机构地区：[1]重钢总医院神经内科,400080

出　　处：《心肺血管病杂志》2025年第3期271-276,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：重庆市科卫联合医学科研项目上项目(2021MSXM115)。

摘　　要：目的:探讨血糖变异性在接受溶栓治疗的缺血性脑卒中患者90天严重残疾或死亡的预测价值。方法:纳入2021年1月至2024年3月间,在重钢总医院神经内科接受静脉溶栓治疗的369例缺血性脑卒中患者。根据住院期间血糖变异系数(glycemic coefficient of variation,GCV)的四分位数将患者分为四组(GCV1-GCV4)。主要终点为90天严重残疾(改良Rankin量表评分≥3)或死亡。采用多因素Logistic回归分析血糖变异性与主要终点的关系,并通过受试者工作特征(receiver operating characteristic,ROC)曲线评估其预测价值。结果:高GCV组男性比例较低、舒张压较低、合并高血压的比例较低、血红蛋白水平较低及格拉斯哥昏迷评分较低;而合并糖尿病的比例较高、平均血糖水平较高。随GCV组别升高,90天严重残疾或死亡率从GCV1组的15%增加到GCV4组的41%。多因素Logistic回归分析表明,GCV2-GCV4组90天严重残疾或死亡的风险逐渐增加,OR分别为1.77(95%CI:0.85~3.80),3.30(95%CI:1.66~6.89)和3.97(95%CI:2.00~8.25)。调整混杂因素后,GCV与90天不良预后仍呈正相关。ROC曲线分析显示,血糖变异性对90天严重残疾或死亡的预测AUC为0.633,血糖变异性联合美国国立卫生院卒中量表评分对90天严重残疾或死亡的AUC为0.711。结论:血糖变异性是接受溶栓治疗的缺血性脑卒中患者90天严重残疾或死亡的独立预测因子,提示在此类患者的管理中应关注并努力减少血糖波动。Objective:To explore the predictive value of glycemic variability in patients with ischemic stroke receiving thrombolytic therapy for severe disability or death within 90 days.Methods:This study enrolled 369 patients with ischemic stroke who received intravenous thrombolysis in the Department of Neuroscience at Chong Gang General Hospital between January 2021 and March 2024.Based on the quartiles of glycemic coefficient of variation(GCV)during hospitalization,patients were categorized into four groups(GCV1-GCV4).The primary endpoint was severe disability at 90 days(modified Rankin Scale score≥3)or death.The relationship between glycemic variability and the primary endpoint was analyzed using multifactorial Logistic regression,and the predictive value was assessed via the receiver operating characteristic(ROC)curve.Results:The high GCV group had a lower proportion of males,lower diastolic blood pressure,lower prevalence of hypertension,lower hemoglobin levels,and lower Glasgow Coma Scale scores;while having a higher prevalence of diabetes and higher average blood glucose levels.With the increase in GCV categories,the 90-day severe disability or mortality rate increased from 15%in the GCV1 group to 41%in the GCV4 group.Multivariate Logistic regression analysis showed that the risk of severe disability or death within 90 days for the GCV2-GCV4 groups,compared to the GCV1 group,gradually increased,with odds ratios(OR)of 1.77,(95%CI:0.85-3.80),3.30(95%CI:1.66-6.89),and 3.97(95%CI:2.00-8.25),respectively.After adjusting for confounding factors,GCV still showed a positive correlation with adverse outcomes at 90 days.The analysis of the ROC curve demonstrated that the area under the curve(AUC)for glycemic variability in predicting severe disability or death within 90 days was 0.633.When glycemic variability was combined with the national institutes of health stroke scale(NIHSS)score,the AUC for predicting severe disability or death within 90 days increased to 0.711.Conclusions:Glycemic variability is an independent pre

关 键 词：缺血性脑卒中 静脉溶栓 血糖变异性 预后 严重残疾 

分 类 号：R54[医药卫生—心血管疾病]