缺血性卒中和短暂性脑缺血发作的二级预防 - 神经内科.ppt

* * 澳大利亚一项针对卒中后持续性高血糖与梗死灶增大和不良临床结局的研究。N=25，采用CGMS检测患者72小时血糖，并同时检测患者指血血糖，与MRI梗死体积及NIHSS、mSR评分进行分析。最终梗死体积变化——急性期梗死体积与结局梗死体积的差异。 Persistent Poststroke Hyperglycemia Is Independently Associated With Infarct Expansion and Worse Clinical Outcome Background and Purpose—Hyperglycemia at the time of ischemic stroke is associated with increased mortality and morbidity. Animal studies suggest that infarct expansion may be responsible. The influence of persisting hyperglycemia after stroke has not previously been examined. We measured the blood glucose profile after acute ischemic stroke and correlated it with infarct volume changes using T2- and diffusion-weighted MRI. Methods—We recruited 25 subjects within 24 hours of ischemic stroke symptoms. Continuous glucose monitoring was performed with a glucose monitoring device (CGMS), and 4-hour capillary glucose levels (BGL) were measured for 72 hours after admission. MRI and clinical assessments were performed at acute (median, 15 hours), subacute (median, 5 days), and outcome (median, 85 days) time points. Results—Mean CGMS glucose and mean BGL glucose correlated with infarct volume change between acute and subacute diffusion-weighted MRI (r0.60, P0.01), acute and outcome MRI (r0.56, P0.01), outcome National Institutes of Health Stroke Scale (NIHSS; r0.53, P0.02), and outcome modified Rankin Scale (mRS; r0.53, P0.02). Acute and final infarct volume change and outcome NIHSS and mRS were significantly higher in patients with mean CGMS or mean BGL glucose 7 mmol/L. Multiple regression analysis indicated that both mean CGMS and BGL glucose levels 7 mmol/L were independently associated with increased final infarct volume change. Conclusions—Persistent hyperglycemia on serial glucose monitoring is an independent determinant of infarct expansion and is associated with worse functional outcome. There is an urgent need to study normalization of blood glucose after stroke. (Stroke. 2003;34:2208-2214.) * Disorders of Glucose Metabolism in