中国卒中杂志 ›› 2022, Vol. 17 ›› Issue (08): 845-850.DOI: 10.3969/j.issn.1673-5765.2022.08.010

• 论著 • 上一篇    下一篇

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

吴倩, 陶立元, 陈思琪, 钟莲梅, 刘丽萍, 米东华   

  1. 1昆明 650032昆明医科大学第一附属医院神经内科 

    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

     

  • 收稿日期:2022-02-28 出版日期:2022-08-20 发布日期:2022-08-20
  • 通讯作者: 米东华midonghua131@163.com

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

  • Received:2022-02-28 Online:2022-08-20 Published:2022-08-20

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≥7 mmol/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。

文章导读: 本研究通过回顾性研究发现血糖控制不稳定或控制不良增加动脉瘤性蛛网膜下腔出血患者迟发性脑缺 血及30 d死亡的风险。

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

Abstract: 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 well-controlled 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.

Key words: Aneurysmal subarachnoid hemorrhage; Blood glucose fluctuation; Delayed cerebral ischemia; Mortality; Prognosis