Stroke：糖尿病、入院血糖较高与卒中溶栓后转归较差相关

糖尿病及入院血糖对卒中溶栓后转归是否存在不利作用尚不清楚。为此，法国巴黎Bichat大学医院神经内科与卒中中心的Jean-PhilippeDesilles博士等进行了一项研究，研究结果在线发表在2013年5月23日的Stroke杂志上。研究结果显示：入院血糖高及糖尿病史与溶栓后临床转归差相关。入院血糖可以作为脑梗死严重程度的替代标志物。

该研究是一项患者注册及系统回归分析。研究人员分析来自患者注册(n=704)的数据，并对之前的观察性研究进行了系统回顾。主要研究结局为获得良好转归（发病3个月时的改良Rankin评分≤2）患者的比例。

研究结果显示：研究人员确认了54篇之前评估糖尿病或入院血糖对溶栓转归作用的报道。在未校正meta分析中纳入了研究注册的数据及之前研究中有效的观察数据，结果显示糖尿病与较差的转归(优势比[OR], 0.76;95%可信区间[CI],0.73–0.79)及更多的症状性脑出血(OR,1.38; 95% CI, 1.21–1.56)相关。不过，在多变量分析中，糖尿病虽然与不良转归依然相关(OR, 0.77; 95% CI, 0.69–0.87)，但与症状性脑出血不相关(OR, 1.11; 95% CI, 0.83–1.48)。校正和未校正的meta分析中，入院血糖较高与较差的转归及更多的症状性脑出血相关。入院血糖每增加1mmol/l，不良转归的校正OR(95% CI) 增加0.92 (0.90–0.94)，而症状性脑出血增加1.09 (1.04–1.14)。

该研究发现：入院血糖及糖尿病史与溶栓后临床转归差相关。入院血糖可以作为脑梗死严重程度的替代标志物，而不是病因。但是，还需要随机对照证据确定溶栓时严格血糖控制对临床转归的重要性。

Diabetes Mellitus, Admission Glucose, and Outcomes After Stroke Thrombolysis: A Registry and Systematic Review.
BACKGROUND AND PURPOSE
The potential detrimental effect of diabetes mellitus and admission glucose level (AGL) on outcomes after stroke thrombolysis is unclear. We evaluated outcomes of patients treated by intravenous or intra-arterial therapy, according to diabetes mellitus and AGL.
METHODS
We analyzed data from a patient registry (n=704) and conducted a systematic review of previous observational studies. The primary study outcome was the percentage of patients who achieved a favorable outcome (modified Rankin score ≤2 at 3 months).
RESULTS
We identified 54 previous reports that evaluated the effect of diabetes mellitus or AGL on outcomes after thrombolysis. In an unadjusted meta-analysis that included our registry data and previous available observational data, diabetes mellitus was associated with less favorable outcome (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.73-0.79) and more symptomatic intracranial hemorrhage (OR, 1.38; 95% CI, 1.21-1.56). However, in multivariable analysis, diabetes mellitus remained associated with less favorable outcome (OR, 0.77; 95% CI, 0.69-0.87) but not with symptomatic intracranial hemorrhage (OR, 1.11; 95% CI, 0.83-1.48). In unadjusted and in adjusted meta-analysis, higher AGL was associated with less favorable outcome and more symptomatic intracranial hemorrhage; the adjusted OR (95% CI) per 1 mmol/L increase in AGL was 0.92 (0.90-0.94) for favorable outcome, and 1.09 (1.04-1.14) for symptomatic intracranial hemorrhage.
CONCLUSIONS
These results confirm that AGL and history of diabetes mellitus are associated with poor clinical outcome after thrombolysis. AGL may be a surrogate marker of brain infarction severity rather than a causal factor. However, randomized controlled evidences are needed to address the significance of a tight glucose control during thrombolysis on clinical outcome.