Abstract:

Objective To observe the feature of capillary permeability in ischemic tissue of patients with acute ischemic stroke (AIS), and analyze the effects of abnormal glucose regulation on the capillary permeability and hemorrhagic transformation of ischemic brain tissue. Methods Patients with AIS were enrolled into study consecutively. Oral glucose tolerance test (OGTT) was performed to diagnose the abnormal glucose regulation in patients with acute ischemic stroke. Computer tomography (CT) perfusion imaging and permeability surface (PS) color map was performed to measure the capillary permeability of ischemic brain tissue. Results A total of 420 cases with AIS were recruited during study period. The capillary permeability of brain tissue with hypoperfusion in patients with diabetes mellitus increased significantly compared with patients with normal glucose regulation (P =0.006). Higher fasting glucose concentration at (14±3) days after onset was identified as an independent risk factor for hemorrhagic transformation after ischemic stroke [odd ratios 1.448, 95% confidence interval (1.017-2.061), P =0.04]. Conclusion The capillary permeability of ischemic brain tissue increased significantly in patients with diabetes mellitus. It was possible that abnormal glucose regulation increased the capillary permeability of ischemic brain tissue, and consequently increased the risk of hemorrhagic transformation.

Key words: Ischemic stroke; Abnormal glucose regulation; Capillary permeability; Hemorrhagic transformation

摘要：

目的 观察急性缺血性卒中患者脑缺血组织毛细血管渗透性变化特点，分析糖调节异常对缺血组织 毛细血管渗透性和发生出血转化的影响。 方法 连续入组的急性缺血性卒中患者，收集患者人口学资料、既往病史、临床信息、实验室指标、 影像资料等。采用口服葡萄糖耐量试验（oral glucose tolerance test，OGTT）进行糖调节异常类型的 诊断。对患者进行计算机体层扫描（computer tomography，CT）灌注成像和渗透性表面（permeabili ty surface，PS）彩色图像叠加后处理，评价缺血脑组织的毛细血管渗透性。对患者进行头颅磁共振梯度 回波成像或CT平扫，评价缺血组织发生出血转化情况。采用Logistic回归模型分析糖调节异常对出血 转化（hemorrhagic transformation，HT）的影响。 结果 研究期间共入组420例急性缺血性卒中患者。与糖调节正常患者相比，合并糖尿病的缺血性卒中 患者脑组织低灌注区的毛细血管渗透性显著升高（P =0.006）。发生出血转化的患者缺血组织毛细血管 渗透性较未发生出血转化者有增加趋势（[ 5.79±3.01）ml/（100 m·l min）vs（4.82±3.29）ml/（100 m·l min）， P =0.530]。Logistic回归分析显示，校正混杂因素后，发病（14±3）d空腹血糖升高，是缺血性卒中后 发生出血转化的独立危险因素[比值比（odd ratios，OR）1.448，95%可信区间（confidence interval，CI） 1.017～2.061，P =0.04）]。 结论 合并糖尿病的缺血性卒中患者缺血组织毛细血管渗透性显著升高；糖调节异常可能通过增 加缺血组织毛细血管渗透性，继而增加卒中患者HT的风险。

关键词: 缺血性卒中; 糖调节异常; 毛细血管渗透性; 出血转化