急性缺血性脑卒中患者接受血管内治疗后的糖尿病状态和血糖指标与预后的关系:对全国性 TREAT-AIS 登记的分析

Meng-Tsang Hsieh, Cheng-Yang Hsieh, Tzu-Hsien Yang, S. Sung, Yi-Chen Hsieh, Chung-Wei Lee, Chun-Jen Lin, Yu-Wei Chen, Kuan-Hung Lin, Pi-Shan Sung, Chih-Wei Tang, Hai-Jui Chu, Kun-Chang Tsai, Chao-Liang Chou, Ching-Huang Lin, Cheng-Yu Wei, Te-Yuan Chen, Shang-Yih Yan, Po-Lin Chen, Chen-Yu Hsiao, Lung Chan, Yen-Chu Huang, Hon-Man Liu, Sung-Chun Tang, I-Hui Lee, L. Lien, Hung-Yi Chiou, Jiunn-Tay Lee, J. Jeng
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引用次数: 0

摘要

高血糖会影响急性缺血性卒中(AIS)血管内治疗(EVT)的疗效。本研究利用全国范围内的登记数据,比较了糖尿病状态和血糖指标对 EVT 治疗结果的预测能力。研究纳入了台湾急性缺血性卒中血管内血栓切除术登记处的 1097 名接受 EVT 治疗的 AIS 患者。分析的变量包括糖尿病状态、入院血糖、糖化血红蛋白(HbA1c)、入院血糖与HbA1c比值(GAR)以及90天不良功能预后(改良Rankin量表评分≥2)和症状性颅内出血(SICH)等结果。多变量分析研究了糖尿病状态和血糖测量对预后的独立影响。多变量分析表明,与无糖尿病的患者相比,已知患有糖尿病的患者出现不良功能预后(比值比 [ORs] 2.10 至 2.58)和 SICH(比值比 3.28 至 4.30)的可能性更高。入院血糖和 GAR 四分位数越高,功能预后越差,SICH 越高。HbA1c 四分位数越高,功能预后越差。然而,与最低四分位数(<5.6%)的患者相比,第二四分位数(5.6-5.8%)的患者功能预后良好的趋势并不明显。ROC分析表明,糖尿病状态和入院血糖对不良功能预后的预测能力较高,而入院血糖和GAR对SICH的预测能力较强。入院血糖可能是最适合预测EVT术后结果的血糖指标。
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Associations of diabetes status and glucose measures with outcomes after endovascular therapy in patients with acute ischemic stroke: an analysis of the nationwide TREAT-AIS registry
Hyperglycemia affects the outcomes of endovascular therapy (EVT) for acute ischemic stroke (AIS). This study compares the predictive ability of diabetes status and glucose measures on EVT outcomes using nationwide registry data.The study included 1,097 AIS patients who underwent EVT from the Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke. The variables analyzed included diabetes status, admission glucose, glycated hemoglobin (HbA1c), admission glucose-to-HbA1c ratio (GAR), and outcomes such as 90-day poor functional outcome (modified Rankin Scale score ≥ 2) and symptomatic intracranial hemorrhage (SICH). Multivariable analyses investigated the independent effects of diabetes status and glucose measures on outcomes. A receiver operating characteristic (ROC) analysis was performed to compare their predictive abilities.The multivariable analysis showed that individuals with known diabetes had a higher likelihood of poor functional outcomes (odds ratios [ORs] 2.10 to 2.58) and SICH (ORs 3.28 to 4.30) compared to those without diabetes. Higher quartiles of admission glucose and GAR were associated with poor functional outcomes and SICH. Higher quartiles of HbA1c were significantly associated with poor functional outcomes. However, patients in the second HbA1c quartile (5.6–5.8%) showed a non-significant tendency toward good functional outcomes compared to those in the lowest quartile (<5.6%). The ROC analysis indicated that diabetes status and admission glucose had higher predictive abilities for poor functional outcomes, while admission glucose and GAR were better predictors for SICH.In AIS patients undergoing EVT, diabetes status, admission glucose, and GAR were associated with 90-day poor functional outcomes and SICH. Admission glucose was likely the most suitable glucose measure for predicting outcomes after EVT.
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