国家神经系统疾病临床医学研究中心数据管理与共享系统

Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

《国家中心数据管理与共享系统操作说明书 —— 研究者部分》

OGTT Glucose Fluctuations and Prognosis in Acute Ischemic Stroke Patients without Diabetes Mellitus History

第一作者：Rui Wang；Jin Fu

通讯作者：Feng Wang

Acute ischemic stroke 2-h post-load minus fasting plasma glucose Diabetes mellitus Oral glucose tolerance test ACROSS-China study

基本信息

2023-03-09

已发表文章

发表杂志：Cerebrovasc Dis

发表类型: Full Paper

影响因子(IF): 3.104

PMID: 36893741 Pubmed原文链接 全文下载

主要研究背景及目的

急性缺血性卒中后的高血糖与更大的梗死体积和更差的功能有关，急性缺血性卒时血糖值与12个月预后之间存在J型关联，即低血糖和高血糖都是危险的[1]。血糖变异性又称血糖波动，是独立于糖化血红蛋白、空腹血糖、餐后血糖衡量血糖控制状况的指标，可以更全面地反映血糖的变化情况。目前研究表明，血糖变异能够独立预测糖尿病患者死亡率或血管并发症的发生的敏感指标[2]。然而，血糖变异与急性缺血性卒中患者预后之间关系尚不清楚。此外，在伴糖代谢异常的急性卒中患者人群中，血糖相关指标对其预后影响的研究也相对较少。因此，我们提出假设：1.血糖变异是急性缺血性卒中患者预后不良的风险因素；2.在伴有糖代谢异常急性缺血性卒中患者人群中，血糖变异是患者预后不良的风险因素。由于目前血糖变异的定义尚不明确，临床和大型流行病学研究中对血糖变异的监测较为复杂。最常见的血糖波动发生在餐后，空腹和餐后血糖水平的差异可能在一定程度上反映了血糖变异的状态[3]。因此，我们通过ACROSS-China数据库，⑴分析血糖变异（空腹和餐后2h血糖差值）对急性缺血性卒中患者预后影响；⑵分析血糖变异（空腹和餐后2h血糖差值）对合并糖代谢异常（既往糖代谢异常和新诊断糖代谢异常）的缺血性卒中患者预后影响；⑶分析血糖变异（OGTT空腹和OGTT 2h血糖差值，避免患者因进食食物不同引起的偏倚）对新诊断糖代谢异常的缺血性卒中患者预后影响。通过以上研究阐明血糖变异与急性缺血性卒中患者或伴糖代谢异常的急性缺血性卒中患者不良预后的风险关系。

方法

1,214 AIS patients without DM history, obtained from ACROSS-China, were divided into 4 quartiles, based on 2hPG-FPG measurements obtained 14 days post-admission. Four models were constructed using multivariate Cox and logistic regression analyses, based on the inclusion of age, gender, trial of ORG 10172 in acute stroke treatment, NIH Stroke Scale scores (model 1), plus 10 other clinical parameters (model 2), plus newly diagnosed DM (NDDM) post-admission (model 3), plus 2hPG and FPG (model 4). Associations found from those 4 models between 2hPGFPG and 1-year clinical outcomes were confirmed via stratification, multiplicative interaction, sensitivity, and restricted cubic spline analyses.

结论

2hPG-FPG is a relatively specific indicator of poorer 1-year clinical prognoses among AIS patients, independent of NDDM, 2hPG, and FPG post-hospital admission. Therefore, the oral glucose tolerance test could be a useful approach for detecting a higher likelihood for developing poorer prognoses among patients without DM history.

主要结果

The highest quartile of 2hPGFPG, after adjusting for variables, such as stroke severity (model 2), was independently associated with death, stroke recurrence, and mRS ≥2–3 (odds ratio [OR] = 3.95, 2.96, 4.15, and 4.83, respectively, all p < 0.0001). Increased 2hPG-FPG remained independently associated with mRS ≥2–3 in models 3–4, as well as increased mRS ≥2 under stratification analyses among both non-NDDM and NDDM patients.