高水平空腹血糖与缺血性卒中患者静脉溶栓后功能结局的关系分析 Relationship between High Levels of Fasting Blood Glucose and Functional Outcome after Intravenous Thrombolysis in Patients with Ischemic Stroke

目的 探讨空腹血糖与接受静脉溶栓的缺血性卒中患者功能结局的关系。 方法 回顾性收集2018年10月—2020年11月首都医科大学附属北京天坛医院静脉溶栓患者的病历资料。纳入发病4.5 h内接受阿替普酶静脉溶栓的缺血性卒中患者为研究对象，采集相关研究数据（包括空腹血糖等）。研究结局设定为出院时功能结局良好，即mRS评分0～1分。采用多因素logistic回归分析探讨空腹血糖与功能结局的关联性。 结果 共入组205例患者，平均年龄为（63.21±11.67）岁，其中153例（74.63%）患者为男性，入院NIHSS评分为5（3～9）分。其中117例（57.07%）患者出院时功能结局不良，88例（42.93%）患者出院时功能结局良好。功能结局良好的患者空腹血糖水平低于功能结局不良的患者[5.10（4.46～7.06）mmol/L vs. 6.33（5.09～7.79）mmol/L，P=0.001]。多因素logistic回归分析结果显示，校正年龄、性别、NIHSS评分后，空腹血糖水平与接受静脉溶栓功能结局相关（OR 0.876，95%CI 0.774～0.991，P=0.035）；校正年龄、性别、NIHSS评分、桥接取栓后，关联性没有达到统计学意义（OR 0.891，95%CI 0.791～1.004，P=0.058）。 结论 对于接受静脉溶栓的缺血性卒中患者，高水平空腹血糖可能会增加静脉溶栓后出院功能结局不良风险。 Abstract: Objective To investigate the association between fasting blood glucose and functional outcomes in ischemic stroke patients treated with intravenous thrombolysis. Methods The study data of patients treated with intravenous thrombolysis in Beijing Tiantan Hospital, Capital Medical University from October 2018 to November 2020 were collected retrospectively. Ischemic stroke patients who received alteplase intravenous thrombolysis within 4.5 h of onset were included, and study data including fasting blood glucose were collected. The study outcome was set as a good functional outcome at discharge (mRS score 0-1). Multivariate logistic regression analysis was used to investigate the association between the fasting blood glucose and functional outcomes. Results A total of 205 patients were enrolled. The mean age was (63.21±11.67) years. The percentage of male was 153 (74.63%). The admission NIHSS score was 5 (3-9). There were 117 patients (57.07%) who did not have a good functional outcome at discharge and 88 patients (42.93%) who did. Fasting blood glucose levels in patients with good functional outcomes were lower than those in patients with poor functional outcomes [5.10 (4.46-7.06) mmol/L vs. 6.33 (5.09-7.79) mmol/L, P=0.001]. Multivariate logistic regression analysis showed that after adjusting for age, gender, and NIHSS score, there was a correlation between fasting blood glucose level and the outcome of receiving intravenous thrombolysis (OR 0.876, 95%CI 0.774-0.991, P=0.035). After adjusting for age, sex, NIHSS score and mechanical thrombectomy, the association was not statistically significant (OR 0.891, 95%CI 0.791-1.004, P=0.058). Conclusions In ischemic stroke patients undergoing intravenous thrombolysis, high level of fasting blood glucose may increase the risk of adverse discharge outcomes after intravenous thrombolysis.