Chinese General Practice ›› 2022, Vol. 25 ›› Issue (23): 2864-2868.DOI: 10.12114/j.issn.1007-9572.2022.0167

• Article • Previous Articles     Next Articles

Relationship between Stress Hyperglycemia Ratio and Hemorrhagic Transformation Patients after Intravenous Thrombolysis in Acute Ischemic Stroke

  

  1. Department of Neurology, Ningbo Medical Center Lihuili Hospital, Ningbo 315000, China
  • Received:2021-11-06 Revised:2022-03-20 Published:2022-08-15 Online:2022-04-28
  • Contact: Guomin XIE
  • About author:
    QI F T, XIE G M, SUN Q, et al. Relationship between stress hyperglycemia ratio and hemorrhagic transformation patients after intravenous thrombolysis in acute ischemic stroke[J]. Chinese General Practice, 2022, 25 (23) : 2864-2868.

应激性血糖升高比值与急性缺血性卒中静脉溶栓后出血转化的相关性研究

  

  1. 315000 浙江省宁波市医疗中心李惠利医院神经内科
  • 通讯作者: 谢国民
  • 作者简介:
    戚飞腾,谢国民,孙琪,等. 应激性血糖升高比值与急性缺血性卒中静脉溶栓后出血转化的相关性研究[J]. 中国全科医学,2022,25(23):2864-2868. [www.chinagp.net] 作者贡献:戚飞腾提出研究思路,设计研究方案及确定研究方法并负责论文起草;赵翠对研究进行可行性分析并确定具体实施方案,收集、整理临床资料;胡凯凯、孙琪进行影像学出血转化的判定;张晓玲进行数据分析与统计学处理,并对统计结果进行解释;谢国民负责论文最终稿的修订、论文的质量控制及审校,对论文整体负责,监督管理;所有作者确认了论文的最终稿。
  • 基金资助:
    浙江省医药卫生项目(2021KY1033)

Abstract:

Background

Hemorrhagic transformation (HT) is a common complication after intravenous thrombolysis in acute ischemic stroke (AIS), but biomarkers for predicting HT are currently lacking. There is a certain correlation between stress hyperglycemia ratio (SHR) and HT of AIS, but whether SHR is related to the hemorrhagic transformation after intravenous thrombolysis is not very clear.

Objective

To investigate the relationship between SHR and HT after intravenous thrombolysis in patients with AIS.

Methods

A total of 320 patients who received recombinant tissue plasminogen activator thrombolytic therapy in Ningbo Medical Center Lihuili Hospital from January 2018 to June 2021 were selected. The clinical data was collected and the value of SHR was calculated. The patients were divided into hemorrhagic transformation group (n=58) and non-hemorrhagic transformation group (n=262) according to the CT/MRI results during the acute period. The demographic data, past medical history, laboratory examination and other clinical data were compared between HT group and non-HT group. Multivariate Logistic regression analysis was used to explore the influencing factors of hemorrhagic transformation in patients with AIS after intravenous thrombolysis; according to the third quartile of SHR, the patients were divided into low SHR group (n=236) and high SHR group (n=84), and the incidence of hemorrhagic transformation was compared between the two groups; according to whether AIS patients had diabetes, the patients were divided into diabetes group (n=79) and non-diabetic group (n=241), and then according to the third quartile of SHR, the groups were divided into low SHR subgroup and high SHR subgroup to explore the influence of diabetes on the relationship between SHR and hemorrhagic transformation.

Results

Age, baseline National Institutes of Health Stroke Scale (NIHSS) score, percentage of atrial fibrillation, and SHR in the hemorrhagic transformation group were higher than those in the non-hemorrhagic transformation group (P<0.05). Multivariate Logistic regression analysis showed that the baseline NIHSS score〔OR=1.041, 95%CI (1.003, 1.080) 〕 and SHR〔OR=3.328, 95%CI (1.304, 8.491) 〕 were the influencing factors of acute hemorrhagic transformation after intravenous thrombolysis in AIS patients (P<0.05). The incidence of hemorrhagic transformation in the high SHR group〔29.76% (25/84) 〕 was higher than that in the low SHR group〔13.98% (33/236) 〕 (P<0.05). After adjusting age, baseline NIHSS score, and atrial fibrillation as control variables, multivariate Logistic regression analysis showed that high SHR was an risk factor for acute hemorrhagic transformation in patients with AIS after intravenous thrombolysis〔OR=2.244, 95%CI (1.215, 4.146), P=0.010〕. In the diabetes group, the incidence of HT in the high SHR subgroup〔36.00% (9/25) 〕 was higher than that in the low SHR subgroup〔14.81% (8/54) 〕 (P<0.05). In the non-diabetic group, the incidence of HT in the high SHR subgroup〔28.81% (17/59) 〕 was higher than that in the low SHR subgroup〔13.19% (24/182) 〕 (P<0.05) .

Conclusion

High SHR is an independent risk factor of hemorrhagic transformation after intravenous thrombolysis of AIS, and has nothing to do with diabetes.

Key words: Ischemic stroke, Thrombolysis, Stress hyperglycemia ratio, Hemorrhage transformation, Blood glucose, Glycosylated hemoglobin, Diabetes mellitus

摘要:

背景

出血转化是急性缺血性卒中(AIS)静脉溶栓后常见并发症,目前缺乏预测出血转化的生物学标志物。应激性血糖升高比值(SHR)与AIS出血转化存在一定相关性,但SHR是否与静脉溶栓后出血转化有关尚未十分明确。

目的

探究SHR与AIS静脉溶栓后出血转化的关系。

方法

选取2018年1月至2021年6月在宁波市医疗中心李惠利医院接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的AIS患者320例。收集患者的临床资料,计算SHR。根据急性期内复查CT/磁共振成像(MRI)结果,将患者分为出血转化组(n=58)和无出血转化组(n=262)。比较两组人口学资料、既往病史、实验室检查指标等。采用多因素Logistic回归分析探究AIS患者静脉溶栓后出血转化的影响因素;根据SHR第三四分位数,将患者分为低SHR组(n=236)和高SHR组(n=84),比较两组出血转化发生率;根据AIS患者是否患有糖尿病,将患者分为糖尿病组(n=79)和非糖尿病组(n=241),再根据SHR第三四分位数,分别将患者分为低SHR亚组和高SHR亚组,探讨糖尿病对SHR与出血转化关系的影响。

结果

出血转化组年龄、基线美国国立卫生研究院卒中量表(NIHSS)评分、心房颤动所占比例及SHR高于无出血转化组(P<0.05)。多因素Logistic回归分析结果显示,基线NIHSS评分〔OR=1.041,95%CI(1.003,1.080)〕、SHR〔OR=3.328,95%CI(1.304,8.491)〕是AIS患者静脉溶栓后出血转化的影响因素(P<0.05)。高SHR组的出血转化发生率〔29.76%(25/84)〕高于低SHR组〔13.98%(33/236)〕(P<0.05)。进一步调整年龄、基线NIHSS评分、心房颤动作为控制变量进行多因素Logistic回归分析,结果显示,高SHR是AIS患者静脉溶栓后出血转化的危险因素〔OR=2.244,95%CI(1.215,4.146),P=0.010〕。糖尿病组中,高SHR亚组出血转化发生率〔36.00%(9/25)〕高于低SHR亚组〔14.81%(8/54)〕(P<0.05);非糖尿病组中,高SHR亚组出血转化发生率〔28.81%(17/59)〕高于低SHR亚组〔13.19%(24/182)〕(P<0.05)。

结论

高SHR是AIS患者静脉溶栓后出血转化的独立危险因素,且与是否患有糖尿病无关。

关键词: 缺血性卒中, 溶栓, 应激性血糖升高比值, 出血转化, 血糖, 糖化血红蛋白, 糖尿病