应激性高血糖比值预测急性缺血性脑卒中患者溶栓治疗后1年不良预后的价值

doi:10.16150/j.1671-2870.2021.06.009

摘要/Abstract

摘要：

目的: 探讨应激性高血糖比值（stress hyperglycemia ratio,SHR）预测急性缺血性脑卒中患者出院后1年内出现不良预后的价值。方法: 收集2018年1月至2020年1月在我院接受溶栓治疗的急性缺血性脑卒中患者262例,其中糖尿病84例,非糖尿病178例。根据患者入院24 h内的平均SHR（非糖尿病组0.859,糖尿病组0.914）,依据是否高于平均水平,将糖尿病及非糖尿病患者分别分为低SHR组和高SHR组。比较糖尿病及非糖尿病患者中低SHR组与高SHR组的一般临床资料和出院1年内的死亡率。用Cox单因素和多因素回归分析,观察患者出院后1年内预后不良的独立危险因素,用受试者操作特征（receiver operating curve,ROC）曲线评估SHR预测患者出院后1年内出现不良预后的临床价值。结果: 非糖尿病患者和糖尿病患者中高SHR组的NIHSS评分、应激性高血糖发病率、空腹血糖和糖化血红蛋白水平均高于低SHR组（P<0.05）。非糖尿病高SHR组出院后1年内的死亡率为32.9%（28/85）,高于非糖尿病低SHR组17.2%（16/93）, χ²=5.910,P=0.015;糖尿病高SHR组出院后1年内的死亡率为48.9%（22/45）,高于糖尿病低SHR组(17.9%,7/39）, χ²=8.848,P=0.003）;且非糖尿病高SHR组出院后1年内的死亡率低于糖尿病高SHR组,差异有统计学意义（ χ²=4.075,P=0.044）。多因素分析提示,NIHSS评分、应激性高血糖、糖化血红蛋白和SHR水平是影响所有急性缺血性脑卒中患者出院后1年预后的独立危险因素。SHR预测急性缺血性脑卒出院后1年不良结局的曲线下面积为0.841,95%CI为0.804~0.861,预测非糖尿病急性缺血性脑卒中患者的曲线下面积为0.897（95%CI为0.814~0.913）。结论: 高SHR影响急性缺血性脑卒中患者接受溶栓治疗出院后1年的存活率,是患者预后不良的独立危险因素。

关键词: 急性缺血性脑卒中, 应激性高血糖比值, 不良预后, 危险因素

Abstract:

Objective: To explore the association of stress-induced hyperglycemia ratio (SHR) and the prognosis of patients with acute ischemic stroke one year after thrombolytic therapy. Methods: A total of 262 patients with acute ischemic stroke, including 84 diabetics and 178 non-diabetics, who received thrombolytic therapy from January 2018 to January 2020 were enrolled in the study. The average levels of SHR calculated within 24 hours of admission were 0.859 and 0.914 in non-diabetics and diabetics, and patients were divided into low and high SHR group, with SHR below or above average level. The general clinical parameters and the mortality rate within 1 year after discharge were compared among diabetic and non-diabetics in low and the high SHR group. Cox univariate and multivariate regression were adopted in independent risk factor analysis for prognosis, and the Receiver operating curve (ROC) was plotted to evaluate the SHR in prognosis prediction. Results: Both diabetic and nondiabetic patients in high SHR group had higher NIHSS score, incidence of stress hyperglycemia, fasting blood glucose and glycosylated hemoglobin levels than patients in low SHR groups (P<0.05). The 1-year mortality rate of the non-diabetic and diabetic high SHR groups were 32.9%(28/85) and 48.9% (22/45), which were higher than their counterparts in low SHR groups, with 17.2%(16/93) and 17.9% (7/39) respectively ( χ²=5.910, P=0.015; and χ²=10.008, P=0.002). For patients with high SHR, the diabetics had higher 1-year mortality rate than the non-diabetics( χ²=4.075, P=0.044). NIHSS score, stress hyperglycemia, glycosylated hemoglobin, and SHR levels were all independent risk factors for the prognosis of patients 1 year after discharge. The ROC curve of SHR for adverse outcomes within one year after discharge revealed the AUC of 0.897 (95%CI=0.814-0.913) and 0.841(95%CI=0.804-0.861) in diabetics and non-diabetics with acute ischemic stroke respectively. Conclusions: High SHR is associated with decreased 1-year survival rate after thrombolytic therapy for acute ischemic stroke and is an independent risk factor for poor prognosis.

Key words: Acute ischemic stroke, Stress hyperglycemia ratio, Poor prognosis, Risk factors

中图分类号:

R743.3

梁亚丽, 赵海港, 项广宇. 应激性高血糖比值预测急性缺血性脑卒中患者溶栓治疗后1年不良预后的价值[J]. 诊断学理论与实践, 2021, 20(06): 562-566.

LIANG Yali, ZHAO Haigang, XIANG Guangyu. The stress-induced hyperglycemia ratio in the prognosis prediction of patients with acute ischemic stroke one year after thrombolytic therapy[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(06): 562-566.

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因素	非糖尿病组		t/χ²	P值	糖尿病组		t/χ²值	P值
因素	低SHR组	高SHR组	t/χ²	P值	低SHR组	高SHR组	t/χ²值	P值
性别（男/女）	54/39	52/33	0.179	0.673	25/14	26/19	0.350	0.554
年龄（岁）	65.3±3.6	66.1±4.1	0.872	0.386	66.2±3.1	66.8±4.3	0.512	0.698
体指数（kg/m²）	24.3±3.2	24.8±3.6	0.745	0.415	24.5±3.6	25.1±3.3	0.841	0.412
高血压病史	48（51.6）	47（55.3）	0.242	0.623	25（64.1）	27（60.0）	1.161	0.281
血脂异常	44（47.3）	43（50.6）	0.191	0.662	15（38.5）	18（40.0）	0.021	0.886
冠心病史	12（12.9）	13（15.3）	0.210	0.647	7（17.9）	9（20.0）	0.057	0.811
吸烟史	60（64.5）	56（65.9）	0.037	0.848	20（51.3）	24（53.3）	0.035	0.851
NIHSS评分（分）	10.6±2.5	14.6±3.1	5.025	<0.001	12.3±3.2	16.3±3.6	5.362	<0.001
应激性高血糖	4（4.3）	27（31.8）	23.289	<0.001	10（25.6）	32（71.1）	17.297	<0.001
空腹血糖（mmol/L）	5.1±0.4	6.5±1.1	3.854	0.010	8.3±2.1	10.9±3.2	4.230	0.004
HbA1c（%）	4.6±0.5	5.1±0.3	3.562	0.026	8.1±1.5	9.5±1.7	3.421	0.030
甘油三酯（mmol/L）	1.7±0.6	1.8±0.8	0.652	0.562	2.1±0.5	2.3±0.8	0.472	0.685
总胆固醇（mmol/L）	4.2±0.8	4.4±0.8	1.256	0.108	4.4±0.9	4.5±1.0	0.068	0.914
高密度脂蛋白（mmol/L）	1.0±0.3	1.1±0.3	0.582	0.625	0.9±0.3	1.0±0.2	0.652	0.514
低密度脂蛋白（mmol/L）	2.8±0.7	2.6±0.7	1.325	0.085	2.5±0.8	2.6±0.8	0.952	0.301

结局	非糖尿病组		糖尿病组
结局	低SHR组	高SHR组	低SHR组	高SHR组
死亡	16（17.2）	28（32.9）	7（17.9）	23（51.1）
存活	77（82.8）	57（67.1）	32（82.1）	22（48.9）
χ²（P）	5.910（0.015）		8.848（0.003）

因素	单因素		多因素
因素	OR值（95%CI）	P值	OR值（95%CI）	P值
NIHSS评分	1.526（1.025~3.362）	0.021	1.325（1.007~3.054）	0.035
应激性高血糖发生率	1.625（1.201~5.230）	0.006	1.481（1.052~4.321）	0.010
空腹血糖	1.025（1.008~1.325）	0.016	1.021（0.985~1.265）	0.068
HbA1c	1.652（1.214~4.326）	0.004	1.526（1.158~3.415）	0.016
SHR	1.526（1.107~4.182）	0.014	1.214（1.010~2.869）	0.026