[1]高朋涛 富奇志.血糖变异性与重症脑出血患者神经功能恢复的相关性[J].卒中与神经疾病杂志,2020,27(05):604-608613.[doi:10.3969/j.issn.1007-0478.2020.05.010]
　Gao Pengtao,Fu Qizhi..The correlation between blood glucose variability and neurological function recovery in patients with severe cerebral hemorrhage[J].Stroke and Nervous Diseases,2020,27(05):604-608613.[doi:10.3969/j.issn.1007-0478.2020.05.010]
点击复制

血糖变异性与重症脑出血患者神经功能恢复的相关性()
分享到：

《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第27卷
期数:
2020年05期
页码:
604-608613
栏目:
论 著
出版日期:
2020-10-20

文章信息/Info

Title:
The correlation between blood glucose variability and neurological function recovery in patients with severe cerebral hemorrhage
文章编号:
1007-0478(2020)05-0604-06
作者:
高朋涛 富奇志
Author(s):
Gao Pengtao;  Fu Qizhi.
The First Affiliated Hospital of Clinical Medicine College of Henan University of Science and Technology, Luoyang Henan 471003
关键词:
血糖变异性 重症脑出血 神经功能恢复 时间轴 相关性
Keywords:
Blood glucose variability Severe cerebral hemorrhage Neurological recovery The timeline Correlation
分类号:
R743.34
DOI:
10.3969/j.issn.1007-0478.2020.05.010
文献标志码:
A
摘要:
目的 探讨血糖变异性对重症急性脑出血患者神经功能恢复的影响及血糖变异性在重症脑出血患者发病时间轴上的表现特点。方法 选取2018年1月1日-2019年7月1日收入河南科技大学第一附属医院重症外科的脑出血患者,根据患者入院30 d后改良Rankin(Modified Rankin scale,mRS)评分将患者分为神经功能恢复良好组(mRS≤2分),和神经功能恢复不良组(mRS>2分)(残疾/死亡),比较2组入院时高血糖、平均血糖、血糖标准差、入院24 h内血糖变异性(CV1)、入院1～3 d血糖变异性(CV2)、入院3～7 d血糖变异性(CV3)、入院7 d内血糖平均变异性(CV7)、最低血糖水平以及其他临床资料,应用多变量logistic回归分析确定入院30 d后神经功能恢复的独立预测因素。结果 单因素分析显示年龄、CV1、CV3、CV7、最低血糖水平、血糖标准差是影响重症脑出血患者神经功能恢复的相关因素(P<0.05); 多因素logistic逐步回归模型分析显示血糖标准差、CV1、CV3、CV7、最低血糖水平能独立预测重症脑出血患者神经功能的恢复情况; 神经功能恢复良好组和神经功能恢复不良组患者的血糖变异性在入院24 h内、入院1～3 d和入院3～7 d时间轴上的变化特点不同(F=5.000,P=0.029),进一步分析可以看出神经功能恢复不良组的血糖变异性平均幅度较神经功能恢复良好组高,但2组在时间轴上的变化趋势基本相同,均在急性期(入院1～3 d)呈线性上升趋势,之后趋于下降; 组内效应显示患者的血糖变异性在3个时间段上的变化具有显著差异(F=11.663,P<0.001)。结论 血糖标准差、CV1、CV3、CV7、最低血糖水平是影响重症脑出血患者神经功能恢复的独立危险因素; 在重症脑出血患者超急性期、急性期、亚急性期过程中血糖变异性的变化具有显著差异,临床工作中重症脑出血患者应在入院早期密切监测血糖,并积极干预,减小血糖波动范围,以期减少不良预后的发生。
Abstract:
ObjectiveTo explore the effects of blood glucose variability on neurological function recovery in patients with severe acute hemorrhagic stroke and the expressive characteristics of blood glucose variability in patients with severe cerebral hemorrhage at different periods.Methods The clinical data of 164 patients with severe cerebral hemorrhage admitted to the department of critical surgery, the first affiliated hospital of Henan university of science and technology were analyzed retrospectively.According to the results of the modified Rankin Scale(mRS)after 30 days of admission, the patients were divided into the good neurological recovery group(mRS≤2 points)and the poor neurological recovery group(mRS>2 points)(disability/death). The admission hyperglycemia, average blood glucose levels, blood glucose standard deviation, blood glucose variability within 24 days of admission(CV1), 1～3d of admission blood glucose variability(CV2), 3～7d of admission blood glucose variability(CV3), within 7 days of admission mean blood glucose variability(CV7), the lowest blood glucose level and other clinical data are compared between two groups. Multivariate logistic regression analysis was used to determine independent predictors of neurological recovery after1-month of admission.Results The Age, blood glucose standard deviation, the lowest blood glucose level,CV1,CV3 and CV7 showed statistical differences(P<0.05).Multivariate logistic regression model analysis showed that the CV1, CV7, CV3 and the lowest blood glucose level were independent risk factors affecting the neurological function recovery of severe patients with cerebral hemorrhage. The expressive characteristics of blood glucose variability on the time axis: The intergroup effect of patients with good neurological function recovery and patients with poor neurological function recovery showed that the blood glucose variability in two groups was different within 24 hours, 1～3 d and 3～7 d of admission(F=5.000,P=0.029).It could be seen from the chart analysis that the average range of blood glucose variability of patients with good functional recovery was higher than that of patients with poor functional recovery, but the change trend of two groups on the time axis was basically the same, both of which showed a linear upward trend before the acute phase(1～3 d of admission)and then tend to decline. The intra-group effect showed that the changes of blood glucose variability at three time points were statistically significant(F=11.663, P<0.001).Conclusion Blood glucose standard deviation, CV1, CV3, CV7, and the lowest blood glucose level were independent risk factors affecting neurological function recovery in patients with severe cerebral hemorrhage. The changes of blood glucose variability in the hyperacute stage, acute stage and subacute stage of severe patients with intracerebral hemorrhage were significantly different. In clinical practice, patients with severe cerebral hemorrhage should closely monitor blood glucose at the early stage of admission, and actively intervene to reduce the fluctuation range of blood glucose, so as to reduce the occurrence of poor prognosis.

参考文献/References:

[1] Qureshi AI,Mendelow AD,Hanley DF.Intracerebralhaemorrhage[J].Lancet,2009,373(09):60371-60378.
[2] 王小蓉,谭华,彭绍忠,等.大鼠脑出血后高血糖对脑损伤的实验性研究[J].陕西医学杂志,2009,38(4):405-408.
[3] Skrha J,Soupal J,SkrhaJJr,et al.Glucose variability,HbA1c and microvascular complications[J].Rev Endocr Metab Disord,2016,17(1):103-110.
[4] 成涛,杨柳,郭庚,等.脑出血指数对急性脑出血病人预后评估的临床价值[J].中西医结合心脑血管病杂志,2016,14(23):2747-2750.
[5] Monnier L,ColetteC,Owens D R,The application of simple metrics in the assessment of glycaemic variability[J].Diabetes Metab,2018,44(4):313-319.
[6] Krinsley JS.Glycemic variability:a strong Independent predictor of mortality in critically ill patients[J].Crit Care Med,2008,36(11):3008-3013.
[7] Cai Y,WangC,Di W,et al.Correlation between blood glucose variability and the risk of death in patients with severe acute stroke[J].Revue Neurologique,2020,DOI:10.1016/j.neurol.2019.12.003.
[8] Meyfroidt G,Keenan DM,Wang X,et a1.Dynamic characteristics of blood glucose time series during the course of critical illness:effects of intensive insulin therapy and relative association with mortality[J].Crit Care Med,2010,38(4):1021-1029.
[9] SuGong,Mi SH,TaoHong,et al.Impact of admission glycemic variability,glucose,and Glycosylated Hemoglobin on Major Adverse Cardiac Events After Acute Myocardial Infarction[J].Diabetes Caredc12-0925,2013,36(4):1026-1032.
[10] 赵玲,陶志敏.急危重症患者快速血糖测定的临床意义探讨[J].中国实用医药,2008,3(33):71-72.
[11] Jia Q,Zheng HG,ZhaoXingquan,et al.Abnormal glucose regulation in patients with acute stroke across China:prevalence and baseline patient characteristics[J].Stroke,2012,43(3):650-657.
[12] 范学朋,柳梅,尚小珂,等.APACHEⅡ评分与危重患者血糖控制目标值的关系[J].中国急救医学,2013,33(10):921-924.
[13] Sun Wentao,Hu Qunliang,Wang Juan,et a.Prognostic value of early glycosylated hemoglobin and blood glucose levels in patients with basal ganglia cerebral hemorrhage[J].The Journal of International Medical Research,2019,DOI:10.1177/0300060519872036.
[14] Ceriello A,Colagiuri S.International diabetes federation guideline for management of post meal glucose:a review of recommendations[J].Diabet Med,2008,25(10):1464-5491.
[15] Chao S,SiLiu,Yu HF,et al.Glycemic variability and all-cause mortality in patients with diabetes receiving hemodialysis:A prospective cohort study[J].J Diabetes Complications,2020,34(4):107549.
[16] Rangasamy Valluvan,Xu Xinling,Susheela Ammu Thampi,et a1.Comparison of glycemic variability indices blood glucose risk index and coefficient of variation in predicting adverse outcomes for patients undergoing cardiac surgery[J].Journal of Cardiothoracic and Vascular Anesthesia,2020,DOI:10.1053/j.jvca.2019.12.032.
[17] Rothwell PM,Coull AJ,Silver LE,et al.Population-based study of event-rate,incidence,case fatality,and mortality for all acute vascular events in all arterial territories(Oxford Vascular Study)[J].LancetDOI:10.1016/j.jvs,2006,366(19):1773-1783.
[18] Jin C,Li GH,Rexrode KM,et al.Prospective study of fasting blood glucose and intracerebral hemorrhagic risk[J].Stroke,2018,49(1):27-33.
[19] OkazakiTomoya,HifumiToru,Kenya K,et al.Blood glucose variability:AStrong Independent predictor of neurological outcomes in aneurysmal subarachnoid hemorrhage[J].J Intensive Care Med,2018,33(3):10.
[20] Lim,Jae-Sung J,Suh,et al.Effects of glycemic variability and hyperglycemia in acute ischemic stroke on post-stroke cognitive impairments[J].J Diabetes Complications,2018,32(7):682-687.
[21] Dossett LA,Cao H,Mowery NT,et al.Blood glucose variability is associated with mortalityin the surgical intensive care unit[J].Am Surg,2008,74(8):679-685.
[22] Fogelholm R,Murros K,Rissanen A,et al.Admission blood glucose and short term survival in primary intracerebral haemorrhage:a population based study[J].Dkgest of the World Latest Medical InformationDOI:10.1136/jnnp,2003,76(3):349-353.
[23] Teddy YW,JukkaPutaala,Sharma G,et al.Persistent hyperglycemia is associated with increased mortality after intracerebral hemorrhage[J].J Am Heart Assoc,2017,6(8):005760.
[24] 陈江波,娄季宇,王金兰,等.高血糖大鼠脑出血后脑水肿及COX-2的变化[J].中国实用神经疾病杂志,2009,12(23):13-15.
[25] KazumiKimura,YasuyukiIguchi,TakeshiInoue,et al.Hyperglycemia independently increases the risk of early death in acute spontaneous intracerebral hemorrhage[J].J Neurol Sci,2007,25(5):90-94.
[26] PiconiL,QuagliaroL,Ros RD,et al.Intermittent high glucose enhances ICAM-1,VCAM-1,E-selectin and interleukin-6 expression in human umbilical endothelial cells in culture:The role of poly(ADP-ribose)polymerase[J].Journal of Thrombosis&Haemostasis,2004,2(8):1538-7836.
[27] Azuma K,Kawamori R,Toyofuku Y,et al.Repetitive uctuations in blood glucose enhance monocyte adhesion to the endothelium of rat thoracic aorta[J].Arterioscler Thromb Vasc Biol,2006,26(10):2275-2280.
[28] Scalea TM,Bochicchio GV,Bochicchio KM,et al.Tight glycemic control in critically injured trauma patients[J].Ann Surg,2007,246(4):605-610.

备注/Memo

备注/Memo:
作者单位:471003 河南省洛阳市河南科技大学临床医学院、河南科技大学第一附属医院
更新日期/Last Update: 2020-10-20