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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
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E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
刘丽丽1*,许 强2,邱 峰3.高血糖对急性缺血性脑卒中老年患者溶栓后梗死体积与院内预后的影响[J].中华老年多器官疾病杂志,2014,13(10):742~745
高血糖对急性缺血性脑卒中老年患者溶栓后梗死体积与院内预后的影响
Effect of hyperglycemia on infarct volume and in-hospital outcome in elderly patients with acute ischemic stroke after thrombolysis
  
DOI:10.3724/SP.J.1264.2014.000171
中文关键词:  高血糖症;卒中;血栓溶解疗法;预后;老年人
英文关键词:hyperglycemia; stroke; thrombolytic therapy; prognosis; elderly
基金项目:海后卫生部科研课题(BHJ09JD08)
作者单位E-mail
刘丽丽1*,许 强2,邱 峰3 海军总医院:1航空潜水医学专科中心,3神经内科,北京 100048;2解放军总医院心血管内科,北京 100853 xuqmail@163.com 
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中文摘要:
      目的 了解就诊时血糖升高与急性缺血性脑卒中老年患者接受重组组织型纤溶酶原激活剂(rt-PA)溶栓后脑梗死体积变化及院内(发病后1周内)预后的关系。方法 发病后3h接受rt-PA的急性缺血性卒中老年患者,按照就诊血糖分为高血糖组与正常血糖组,采用磁共振检查评价溶栓各时间点血管再通率、脑梗死体积变化,并评价各时间段的国立卫生研究院卒中量表(NIHSS)评分及预后指标。结果 共44例纳入本研究,其中高血糖组24例,正常血糖组20例。溶栓即刻高血糖组患者梗死体积与正常血糖患者相比无明显差异[(29.5±56.2) vs (28.3±61.7),P=0.90],NIHSS评分明显增高[(17.7±6.6) vs (12.9±6.3),P<0.01];高血糖患者溶栓24h后血管再通率与出血转化率相同;发病后24h及1周,高血糖患者脑梗死体积更大[(121.7±101.1) vs (68.8±85.4),P=0.03;(170.8±163.9) vs (92.5±113.6),P=0.02],NIHSS评分更高[(14.3±6.9) vs (8.6±5.1),P<0.01;(8.8±7.4) vs (4.3±3.9),P<0.01],发病后1周,高血糖患者的不良预后的比例比正常血糖者明显升高(42% vs 15%,P=0.05)。结论 就诊时高血糖对脑卒中老年患者rt-PA溶栓血管再通率及安全性无明显影响,高血糖与溶栓后院内梗死延展及预后不良明显相关。
英文摘要:
      Objective To investigate the relationship of admission hyperglycemia with changes in infarct volume and in-hospital outcome (within 1 week after onset) in the elderly patients with acute ischemic stroke after the treatment of recombinant tissue plasminogen activator (rt-PA). Methods All consecutive elderly patients suffering from acute ischemic stroke and treated with rt-PA within 3h after onset in our hospital from 2010 to 2013 were enrolled in the study. They were divided into hyperglycemic group and normoglycemic group according to their blood glucose levels at admission. The recanalization and infarct volume at different time points after onset were evaluated with magnetic resonance scanning. The National Institute of Health Stroke Scale (NIHSS) scores of different time points were also evaluated and compared between the 2 groups. Results There were totally 44 patients enrolled in the study, and 24 of them had admission hyperglycemia. There was no difference in initial infarct volume between the normoglycemic and hyperglycemic groups [(29.5±56.2) vs (28.3±61.7), P=0.90]. However, hyperglycemic patients had higher admission NIHSS scores [(17.7±6.6) vs (12.9±6.3), P<0.01]. No difference was seen in the recanalization and hemorrhage rate between the 2 groups at 24h after onset. In 24h and 7d after onset, hyperglycemic patients had larger stroke volume [(121.7±101.1) vs (68.8±85.4), P=0.03; (170.8±163.9) vs (92.5±113.6), P=0.02], and higher NIHSS scores than normoglycemic patients [(14.3±6.9) vs (8.6±5.1), P<0.01; (8.8±7.4) vs (4.3±3.9), P<0.01]. Hyperglycemic patients also had higher rate of poor prognosis at 7d after onset than normoglycemic group patients (42% vs 15%, P=0.05). Conclusion Admission hyperglycemia does not interfere the early recanalization and safety of rt-PA thrombolysis, but it is associated with in-hospital infarct volume expansion and poor outcome in the elderly acute ischemic stroke patients.
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