动脉瘤性蛛网膜下腔出血急性期高血糖对患者一年死亡的影响

doi:10.3969/j.issn.1673-5765.2016.11.007

摘要/Abstract

摘要：

目的探讨动脉瘤性蛛网膜下腔出血急性期血糖水平对患者长期预后的影响。方法连续入组首都医科大学附属北京天坛医院收治的发病时间在3 d内、无糖尿病病史的动脉瘤性蛛网膜下腔出血患者，分析患者入院、发病14 d空腹血糖以及血糖变化趋势。多因素Cox生存比例回归分析用以评价影响发病1年全因死亡的因素。结果 239例无糖尿病病史的动脉瘤性蛛网膜下腔出血患者进入研究并最终完成全部随访。结果显示入院时空腹血糖越高的患者，1年死亡率越高[危险比（hazard ratio，HR）1.415，95%可信区间（confidence interval，CI ），1.166～1.718]。发病14 d时有85例（36.80%）患者血糖较入院时增高，146例患者血糖较入院时降低或不变，死亡患者中血糖升高比例显著高于存活患者中血糖升高的比例（61.54% vs 33.66%，P =0.006）。Cox生存比例回归分析显示发病14 d血糖升高（HR 1.317， 95%CI 1.132～1.532），患者1年死亡风险越大。结论入院时空腹血糖以及发病14 d内血糖的变化是不伴糖尿病的动脉瘤性蛛网膜下腔出血患者1 年死亡的独立预测因素。

文章导读： 通过对239例无糖尿病病史的动脉瘤性蛛网膜下腔出血患者进行多因素Cox生存比例回归分析，结果显示此类患者中入院时血糖升高、发病14 d内血糖升高是1年全因死亡的独立预测因素。

关键词: 高血糖; 颅内动脉瘤; 蛛网膜下腔出血; 预后; 死亡

Abstract:

Objective To investigate the glucose level at acute phase of aneurysmal subarachnoid hemorrhage (aSAH) on long-term outcome of patients. Methods Patients who were diagnosed as aSAH without history of diabetes and admitted within 3 h after onset by Beijing Tiantan Hospital, Capital Medical University were enrolled to assess fasting glucose on admission, day 14 and their variation. Multivariate Cox regression analysis was used to assess risk factors for 1-year mortality. Results A total of 239 aSAH patients without history of diabetes were enrolled and followed up in this study. Admission glucose levels were found to be positively associated with 1-year mortality (hazard ratio [HR] 1.415, 95% confidence interval [CI ] 1.166-1.718). Within 14 days after onset of disease, there were 85 cases of patients had increased blood glucose level compared with that of on admission and there were 146 cases of patients had decreased or unchanged level of blood glucose compared with that of on admission. The blood glucose increased group had obviously increased mortality rate compared with the decreased and unchanged group (61.54% vs 33.66%, P =0.006). In addition, higher blood glucose levels were also associated with an elevated 1-year mortality (HR 1.317, 95%CI 1.132-1.532). Conclusion Fasting glucose levels at admission and their variation within 14 d after aSAH are predictive factors of an elevated 1-year mortality rate.

Key words: Hyperglycemia; Subarachnoid hemorrhage; Aneurysmal; Outcomes; Mortality

侯宗刚，陶晓刚，田润发，边立衡. 动脉瘤性蛛网膜下腔出血急性期高血糖对患者一年死亡的影响[J]. 中国卒中杂志, 2016, 11(11): 934-941.

HOU Zong-Gang, TAO Xiao-Gang, TIAN Run-Fa, et al.. The Influence of Hyperglycemia at Acute Phase of Aneurysmal Subarachnoid Hemorrhage on One-year Mortality[J]. Chinese Journal of Stroke, 2016, 11(11): 934-941.

参考文献

1 van Gijn J，Kerr RS，Rinkel GJ. Subarachnoid

haemorrhage[J]. Lancet，2007，369：306-318.

2 Br isman JL，Song JK，Newell DW. Cerebral

aneurysms[J]. N Engl J Med，2006，355：928-939.

3 Bonita R，Thomson S. Subarachnoid hemorrhage：

epidemiology，diagnosi s，management，a nd

outcome[J]. Stroke，1985，16：591-594.

4 Lazaridis C，Naval N. Risk factors and medical

management of vasospasm af ter subarachnoid

hemorrhage[J]. Neurosurg Clin N Am，2010，21：353-364.

5 Feigin VL，Rinkel GJ，Lawes CM，et al. Risk factors

for subarachnoid hemorrhage：an updated systematic

review of epidemiological studies[J]. Stroke，2005，36：

2773-2780.

6 Ferguson S，Macdonald RL. Predictors of cerebral

infarction in patients with aneurysmal subarachnoid

hemorrhage[J]. Neurosurgery，2007，60：658-667，

discussion 667.

7 Rosengar t AJ，Schultheiss KE，Tolentino J，et

al. Prognostic factors for outcome in patients with

aneurysmal subarachnoid hemorrhage[J]. Stroke，

2007，38：2315-2321.

8 J e n k i n s J S，Buc k e l l M，Ca r t e r AB，e t a l .

Hypothalamic-pituitary-adrenal function after

subarachnoid haemorrhage[J]. Br Med J，1969，4：

707-709.

9 Baird TA，Parsons MW，Barber PA，et al. The

influence of diabetes mellitus and hyperglycaemia

on stroke incidence and outcome[J]. J Clin Neurosci，

2002，9：618-626.

10 Lanzino G，Kassell NF，Germanson T，et al. Plasma

glucose levels and outcome af ter aneurysmal

subarachnoid hemorrhage[J]. J Neurosurg，1993，79：

885-891.

11 Alb e r t i O，Becker R，Benes L，et a l. Init ial

hyperglycemia as an indicator of severity of the ictus

in poor-grade patients with spontaneous subarachnoid

hemorrhage[J]. Clin Neurol Neurosurg，2000，102：

78-83.

12 Kr u y t ND，Bies sel s GJ，de Ha an R J，e t a l .

Hyperglycemia and clinical outcome in aneurysmal

subarachnoid hemorrhage：a meta-analysis[J]. Stroke，

2009，40：e424-430.

13 Kurtz P，Claassen J，Helbok R，et al. Systemic

glucose variability predicts cerebral metabolic

distress and mortality after subarachnoid hemorrhage：

a retrospective observational study[J]. Crit Care，2014，

18：R89.

14 Kawai N，Keep RF，Betz AL，et al. Hyperglycemia

induces progressive changes i n the cerebral

microvasculature and blood-brain barrier transport

during focal cerebral ischemia[J]. Acta Neurochir

Suppl，1998，71：219-221.

15 van Donkelaar CE，Dijkland SA，van den Bergh WM，

et al. Early circulating lactate and glucose levels after

aneurysmal subarachnoid hemorrhage correlate with

poor outcome and delayed cerebral ischemia：A twocenter

cohort study[J]. Crit Care Med，2016，44：966-

972.

16 Berezhnov ES，Nikolaeva AN. The transition to

the 10th edition of the International Classification of

Diseases[J]. Vopr Kurortol Fizioter Lech Fiz Kult，

1998：54-55.

17 Lee SH，Lim JS，Kim N，et al. Effects of admission

glucose level on mor tality af ter subarachnoid

hemorrhage：a comparison between short-term and

long-term mortality[J]. J Neurol Sci，2008，275：18-21.

18 Bian LH，Liu YF，Nichols LT，et al. Epidemiology of

subarachnoid hemorrhage，patterns of management，

and outcomes in China：a hospital-based multicenter

prospective study[J]. CNS Neurosci Ther，2012，18：

895-902.

19 Berzina G，Sveen U，Paanalahti M，et al. Analyzing

the modified Rankin scale using concepts of the

international classification of functioning，disability

and health[J]. Eur J Phys Rehabil Med，2016，52：203-

213.

20 Sarrafzadeh A，Haux D，Kuchler I，et al. Poor-grade

aneurysmal subarachnoid hemorrhage：relationship

of cerebral metabolism to outcome[J]. J Neurosurg，

2004，100：400-406.

21 Charpentier C，Audiber t G，Guillemin F，et al.

Multivariate analysis of predictors of cerebral

vasospasm occurrence after aneurysmal subarachnoid

hemorrhage[J]. Stroke，1999，30：1402-1408.

22 Yoshimoto Y，Tanaka Y，Hoya K. Acute systemic

inflammatory response syndrome in subarachnoid

hemorrhage[J]. Stroke，2001，32：1989-1993.

23 Fukui S，Katoh H，Tsuzuki N，et al. Multivariate

analysis of risk factors for QT prolongation following

subarachnoid hemorrhage[J]. Crit Care，2003，7：R7-

R12.

24 Hacke W，Kaste M，Skyhoj Olsen T，et al. Acute

treatment of ischemic stroke. European Stroke

Initiative (EUSI)[J]. Cerebrovasc Dis，2000，10 Suppl

3：22-33.

25 Capes SE，Hunt D，Malmberg K，et al. St ress

hyperglycaemia and increased risk of death after

myocardial infarction in patients with and without

diabetes：a systematic overview[J]. Lancet，2000，355：

773-778.

26 Capes SE，Hunt D，Malmberg K，et al. St ress

hyperglycemia and prognosis of stroke in nondiabetic

and diabetic patients：a systematic overview[J]. Stroke，

2001，32：2426-2432.

27 Mocco J，Ransom ER，Komotar RJ，et al. Preoperative

prediction of long-term outcome in poor-grade

aneurysmal subarachnoid hemorrhage[J]. Neurosurgery，

2006，59：529-538，discussion 529-538.

28 Sehba FA，Bederson JB. Mechanisms of acute brain

injury after subarachnoid hemorrhage[J]. Neurol Res，2006，28：381-398.

29 Cross DT，Tirschwell DL，Clark MA，et al. Mortality

rates after subarachnoid hemorrhage：variations

according to hospital case volume in 18 s t a t e s [ J ] . J

Neurosurg，2003，99：810-817.

30 Le Roux PD，Elliott JP，Newell DW，et al. Predicting

outcome in poor-grade patients with subarachnoid

hemorrhage：a retrospective review of 159 aggressively

managed cases[J]. J Neurosurg，1996，85：39-49.

31 Front e r a JA，Fer nandez A，Claassen J，et a l.

Hyperglycemia after SAH：predictors，associated

complications，and impact on outcome[J]. Stroke，

2006，37：199-203.

[1]	王晓蕊, 骆嵩, 邹良玉, 屈洪党, 崔雪, 赵玉洁. 嗜酸性粒细胞与单核细胞比值预测急性缺血性卒中患者静脉溶栓预后的价值研究 [J]. 中国卒中杂志, 2024, 19(9): 1025-1033.
[2]	周宏宇, 李子孝, 王拥军. 基于影像组学预测大脑年龄与缺血性卒中的研究进展[J]. 中国卒中杂志, 2024, 19(9): 1066-1076.
[3]	于丹丹, 秦海强, 王安心, 张晓丽, 左颖婷, 张亚清, 杨波, 魏娜, 张婧. 体重指数对不同严重程度卒中患者短期预后的影响 [J]. 中国卒中杂志, 2024, 19(7): 809-814.
[4]	赵鑫, 薛伟, 祝新莉, 井冬青, 洪帆, 郭筱, 刘君玲. 阵发性睡眠性血红蛋白尿症伴可逆性后部脑病综合征1例报道[J]. 中国卒中杂志, 2024, 19(6): 699-705.
[5]	次央, 胡亚雄, 王其琪, 连雨晴, 陈玉秀, 周立新, 赵玉华. 高原地区卒中后癫痫的临床及预后特征[J]. 中国卒中杂志, 2024, 19(4): 423-430.
[6]	丁则昱, 李光硕, 赵性泉. 高水平空腹血糖与缺血性卒中患者静脉溶栓后功能结局的关系分析[J]. 中国卒中杂志, 2024, 19(3): 293-298.
[7]	张方圆, 薛婧, 许杰, 王拥军. 干预代谢危险因素对脑血管病影响的研究进展[J]. 中国卒中杂志, 2024, 19(2): 131-137.
[8]	王冀伟, 李辉, 刘建峰, 徐丽峰, 毕红玲, 谢雄伟, 田洋洋. 甲壳质酶蛋白-40、半胱氨酸蛋白水解酶-1及ASPECTS预测前循环大面积脑梗死介入取栓患者预后的价值研究[J]. 中国卒中杂志, 2024, 19(10): 1155-1161.
[9]	陈绪斌, 肖炜婷, 岳喜峰, 何能清, 曾小辉. 急性缺血性卒中患者静脉溶栓后血清微小RNA-874-3p、微小RNA-181a-5p及Wnt/β-catenin信号通路与神经功能预后的关系[J]. 中国卒中杂志, 2024, 19(10): 1162-1169.
[10]	王超, 胡永珍, 李雪松. 动脉瘤性蛛网膜下腔出血后分流依赖性脑积水的预测研究进展[J]. 中国卒中杂志, 2024, 19(1): 87-93.
[11]	杨溢, 刘清源, 刘伟奇, 王硕. 基于人工智能的未破裂颅内动脉瘤形态学指标三维测量方法[J]. 中国卒中杂志, 2024, 19(1): 112-119.
[12]	程忻, 仲伟逸, 董漪, 李琦, 倪伟, 谷鸿秋, 顾宇翔, 董强, 中国卒中学会中国脑血管病临床管理指南撰写工作委员会. 中国脑血管病临床管理指南（第2版）（节选）——第6章蛛网膜下腔出血临床管理推荐意见[J]. 中国卒中杂志, 2023, 18(9): 1024-1029.
[13]	周雨萌, 陈丽霞. 急性缺血性卒中机械取栓患者的血压管理研究进展[J]. 中国卒中杂志, 2023, 18(9): 1073-1078.
[14]	霍洁, 徐玢, 张初吉, 陈必耀, 冀瑞俊, 袁靖. 血清淀粉酶升高对急性卒中患者短期死亡的预测价值[J]. 中国卒中杂志, 2023, 18(8): 873-878.
[15]	李光硕, 赵性泉. 英国国家卒中临床指南2023版要点及解读——出血性卒中[J]. 中国卒中杂志, 2023, 18(12): 1365-1369.