Study on the Prognostic Effect of Hyperglycemia in Diabetic and Non-diabetic Patients Treated with Mechanical Thrombectomy

doi:10.3969/j.issn.1673-5765.2018.04.004

Abstract

Abstract:

Objective To investigate the prognostic value of hyperglycemia between diabetic and non-diabetic patients with acute ischemic stroke who received anterior circulation mechanical thrombectomy. Methods Patients included in this analysis were those who were enrolled in Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry (ACTUAL) study and whose glucose level were >8.6 mmol/L. Patients were divided into diabetes and non-diabetes group according to the diagnosis based on diabetic history and admission glycosylated hemoglobin (HbAlc). The poor functional outcomes were defined as modified Rankin Scale (mRS) score 3-6 at 90 d after onset. Results A total of 160 patients whose glucose level were >8.6 mmol/L were included in this study, among which, 82 (51.2%) patients were diabetes and 78 (48.8%) patients were non-diabetes. A total of 114 (71.3%) patients had poor functional outcomes. Non-diabetic patients were more likely to reach poor functional outcomes (83.3% vs 59.8%, P =0.001). After adjusted for confounders including arthrosclerosis cardiac artery disease, hypertension, percentage of lymphocytes in neutrophils, National Institutes Of Health Stroke Scale (NIHSS) score, pucture-blood revascularization and blood glucose on admission, the multivariable logistic regression analysis showed that non-diabetes hyperglycemia still had a high risk of poor functional outcomes than diabetes [odds ratio (OR)=4.2, 95% confidence interval (CI) 1.52-11.56, P =0.006]. Conclusion The deleterious influence of hyperglycemia is more prominent in non-diabetic patients after received mechanical thrombectomy.

Key words: Hyperglycemia; Mechanical thrombectomy; Diabetes; Prognosis

摘要：

目的探讨高血糖对糖尿病与非糖尿病急性缺血性卒中患者前循环取栓预后的影响。方法回顾性纳入急性前循环卒中登记研究中血糖＞8.6 mmol/L的接受前循环机械取栓的急性缺血性卒中患者。根据患者提供的既往糖尿病史和入院时糖化血红蛋白（glycosylated hemoglobin，HbAlc）将患者分为糖尿病组和非糖尿病组。不良功能预后定义为发病90 d后的改良Rankin量表（modified Rankin Scale，mRS）评分3～6分。结果共纳入160例血糖＞8.6 mmol /L的患者，其中82例（51.2%）为糖尿病患者，78例（48.8%）为非糖尿病患者，术后出现不良转归114例（71.3%），非糖尿病组不良转归率显著高于糖尿病组（83.3% vs 59.8%，P =0.001）。校正冠状动脉粥样硬化性心脏病、高血压、中性粒细胞淋巴细胞百分比、基线美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分、穿刺-血管再通时间、入院血糖后，多变量Logistic回归分析显示非糖尿病高血糖是3个月后不良转归的独立预测因素 [比值比（odds ratio，OR）=4.2，95%可信区间（confidence interval，CI）1.52～11.56，P =0.006]。结论高血糖对前循环机械取栓患者不良转归的影响在非糖尿病患者中更加显著。

关键词: 高血糖; 机械取栓; 糖尿病; 预后

WANG Ling, BAI Yong-Jie, ZI Wen-Jie, XU Ge-Lin. Study on the Prognostic Effect of Hyperglycemia in Diabetic and Non-diabetic Patients Treated with Mechanical Thrombectomy[J]. Chinese Journal of Stroke, 2018, 13(04): 311-316.

汪玲, 白永杰, 资文杰, 徐格林. 高血糖对糖尿病与非糖尿病患者前循环取栓预后的影响研究[J]. 中国卒中杂志, 2018, 13(04): 311-316.

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