急性缺血性卒中与血糖波动关系的研究进展

doi:10.3969/j.issn.1673-5765.2018.10.022

摘要/Abstract

摘要： 30%～40%急性期脑梗死患者存在应激性高血糖现象，并且与患者尤其是非糖尿病患者的不良预后相关。强化降糖并未改善这类患者的预后，反而会增加低血糖发生风险。血糖波动是指血糖在波峰波谷间的波动状态，其可以通过氧化应激和炎症反应导致血管内皮细胞凋亡，而急性期脑梗死患者出现应激性高血糖可能是血糖波动的一种表象，未来需要更深入的研究。

文章导读： 本文比较全面地阐述了血糖波动体内外研究及其与急性脑梗死相关临床研究现状及展望。

关键词: 血糖波动；急性缺血性卒中；应激性高血糖

Abstract: Stress hyperglycemia can occur in 30%-40% of patients with acute ischemic stroke, which is associated with poor prognosis, especially those without diabetes. Intensive hyperglycemia management didn’t improve the outcome of such patients, and increased the risk of hypoglycemia instead. Glycemic fluctuation can lead to vascular endothelial cell apoptosis through oxidative stress and inflammatory reaction. Stress hyperglycemia occurring soon after acute ischemic stroke may be just an interesting and special phenomenon of glycemic fluctuation, which still needs further research in the future.

Key words: Glycemic fluctuation; Acute ischemic stroke; Stress hyperglycemia

曹风雅, 邓江山, 赵玉武. 急性缺血性卒中与血糖波动关系的研究进展[J]. 中国卒中杂志, 2018, 13(10): 1114-1117.

CAO Feng-Ya, DENG Jiang-Shan, ZHAO Yu-Wu. Progress in Relationship between Acute Ischemic Stroke and Glycemic Fluctuation [J]. Chinese Journal of Stroke, 2018, 13(10): 1114-1117.

参考文献

1] LIN C C，LI C I，LIU C S，et al. Annual fasting plasma glucose variation increases risk of cancer incidence and mortality in patients with type 2 diabetes：the Taichung Diabetes Study[J]. Endocr Relat Cancer，2012，19（4）：473-483. [2] RISSO A，MERCURI F，QUAGLIARO L，et al. Intermittent high glucose enhances apoptosis in human umbilical vein endothelial cells in culture[J/OL]. Am J Physiol Endocrinol Metab，2001，281（5）：E924-E930. https：//doi.org/10.1152/ ajpendo.2001.281.5.E924. [3] QUAGLIARO L，PICONI L，ASSALONI R，et al. Intermittent high glucose enhances apoptosis related to oxidative stress in human umbilical vein endothelial cells：the role of protein kinase C and NAD（P）H-oxidase activation[J]. Diabetes，2003，52 （11）：2795-2804. [4] QUAGLIARO L，PICONI L，ASSALONI R，et al. Intermittent high glucose enhances ICAM-1，VCAM1 and E-selectin expression in human umbilical vein endothelial cells in culture：the distinct role of protein kinase C and mitochondrial superoxide production[J]. Atherosclerosis，2005，183（2）：259-267. [5] WU N，SHEN H，LIU H，et al. Acute blood glucose fluctuation enhances rat aorta endothelial cell apoptosis，oxidative stress and pro-inflammatory cytokine expression in vivo[J]. Cardiovasc Diabetol， 2016，15（1）：109. [6] CERIELLO A，ESPOSITO K，PICONI L，et al. Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients[J]. Diabetes， 2008，57（5）：1349-1354. [7] RIBO M，MOLINA C A，DELGADO P，et al. Hyperglycemia during ischemia rapidly accelerates brain damage in stroke patients treated with Tpa[J]. J Cereb Blood Flow Metab，2007，27（9）：1616-1622. [8] CAPES S E，HUNT D，MALMBERG K，et al. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients：a systematic overview[J]. Stroke，2001，32（10）：2426-2432. [9] SHIMOYAMA T，KINMURA K，UEMURA J，et al. Elevated glucose level adversely affects infarct volume growth and neurological deterioration in non-diabetic stroke patients，but not diabetic stroke patients[J]. Eur J Neurol，2014，21（3）：402-410. [10] POPPE A Y，MAJUMDAR S R，JEERAKATHIL T，et al. Admission hyperglycemia predicts a worse outcome in stroke patients treated with intravenous thrombolysis[J]. Diabetes Care，2009，32（4）：617- 622. [11] TZIOMALOS K，DIMITRIOU P，BOUZIANA S D， et al. Stress hyperglycemia and acute ischemic stroke in-hospital outcome[J/OL]. Metabolism，2017，67：99- 105. http：//dx.doi.org/10.1016/j.metabol.2016.11.011. [12] GRAY C S，HILDRETH A J，SANDERCOCK P A，et al. Glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia：the UK Glucose Insulin in Stroke Trial（GIST-UK）[J]. Lancet Neurol，2007，6（5）：397-406. [13] BRUNO A，KENT T A，COULL B M，et al. Treatment of hyperglycemia in ischemic stroke （THIS）：a randomized pilot trial[J]. Stroke，2008， 39（2）：384-389. [14] JOHNSTON K C，HALL C E，KISSELA B M，et al. Glucose Regulation in Acute Stroke Patients（GRASP） trial：a randomized pilot trial[J]. Stroke，2009，40 （12）：3804-3809. [15] ZHANG J W，HE L J，CAO S J，et al. Effect of glycemic variability on short term prognosis in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions[J/ OL]. Diabetol Metab Syndr，2014，6：76. https：//doi. org/10.1186/1758-5996-6-76. [16] TERAGUCHI I，IMANISHI T，OZAKI Y，et al. Acute-phase glucose fluctuation is negatively correlated with myocardial salvage after acute myocardial infarction[J]. Circ J，2014，78（1）：170-179. [17] SU G，MI S H，TAO H，et al. Impact of admission glycemic variability，glucose，and glycosylated hemoglobin on major adverse cardiac events after acute myocardial infarction[J]. Diabetes Care，2013， 36（4）：1026-1032. [18] BARLETTA J F，FIGUEROA B E，DESHANE R，et al. High glucose variability increases cerebral infarction in patients with spontaneous subarachnoid hemorrhage[J]. J Crit Care，2013，28（5）：798-803. [19] BAIRD T A，PARSONS M W，PHAN T，et al. Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome[J]. Stroke，2003，34（9）：2208-2214. [20] SHIMOYAMA T，KIMURA K，UEMURA J，et al. Post stroke dysglycemia and acute infarct volume growth：a study using continuous glucose monitoring[J]. Eur Neurol，2016，76（3-4）：167-174. [21] YU J，ZHANG C G，ZHANG S P，et al. Inordinate glucose variation poststroke is associated with poor neurological improvement in patients without history of diabetes[J]. CNS Neurosci Ther，2014，20（6）： 503-508. [22] 张名扬，吕肖峰，张微微，等. 2型糖尿病合并急性脑梗死患者血糖波动对体内氧化应激水平的影响及意义[J]. 中国全科医学，2014，17（7）：784-787. [23] MELAMED E. Reactive hyperglycaemia in patients with acute stroke[J]. J Neurol Sci，1976，29（2-4）： 267-275.

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