摘要
高血糖被认为是急性缺血性卒中患者死亡、功能转归不良、有症状脑出血和梗死体积增大的预测因素。许多研究通过使用标准差、变异系数、血糖水平、应激性高血糖比和葡萄糖/糖化血红蛋白比等参数来表示高血糖,进而研究高血糖与卒中转归的关系。在接受静脉溶栓治疗的卒中患者中,高血糖与有症状脑出血、神经功能转归不良以及血管再通率较低密切相关;在接受血管内机械血栓切除术的卒中患者中,高血糖与远期转归不良、病死率增高以及梗死体积增大密切相关。然而,高血糖是否会影响急性缺血性卒中的再灌注治疗效果尚存在争议。高血糖导致缺血性卒中患者再灌注治疗后转归不良的可能机制包括抑制血管舒张、降低血浆纤溶活性、破坏血脑屏障、促进氧化应激以及导致缺血半暗带体积减少等。研究表明,对于伴有高血糖的卒中患者,强化血糖控制并没有带来显著益处。因此,急性缺血性卒中合并高血糖患者的血糖控制方案需要进一步研究探讨。
Hyperglycemia is considered to be a predictor of death,poor functional outcome,symptomatic intracerebral hemorrhage,and increased infarct volume in patients with acute ischemic stroke.Many studies have used parameters such as standard deviation,coefficient of variation,blood glucose level,stress hyperglycemia ratio,and glucose/glycated hemoglobin ratio to express hyperglycemia,and then study the relationship between hyperglycemia and stroke outcome.In patients with stroke receiving intravenous thrombolysis,hyperglycemia is closely associated with symptomatic intracerebral hemorrhage,poor neurological outcome,and lower vascular recanalization rate.In patients with stroke undergoing endovascular mechanical thrombectomy,hyperglycemia is closely associated with poor long-term outcome,increased mortality,and increased infarct volume.However,whether hyperglycemia will affect the effect of reperfusion therapy in acute ischemic stroke remains controversial.The possible mechanisms of hyperglycemia leading to poor outcomes after reperfusion therapy in patients with ischemic stroke include inhibition of vasodilation,reduction of plasma fibrinolytic activity,destruction of the blood-brain barrier,promotion of oxidative stress,and reduction of ischemic penumbra volume.Studies have shown that for stroke patients with hyperglycemia,intensive blood glucose control does not bring significant benefits.Therefore,the blood glucose control program of patients with acute ischemic stroke and hyperglycemia needs further study and discussion.
作者
刘婷婷
张广慧
Liu Tingting;Zhang Guanghui(Department of Neurology,Lianyungang Hospital Affiliated to Xuzhou Medical University,Lianyungang First People's Hospital,Lianyungang 222002,China)
出处
《国际脑血管病杂志》
2021年第1期32-37,共6页
International Journal of Cerebrovascular Diseases
关键词
卒中
脑缺血
高血糖症
高血糖
血栓溶解疗法
血管内手术
血栓切除术
治疗结果
Stroke
Brain ischemia
Hyperglycemia
Blood glucose
Thrombolytic therapy
Endovascular procedures
Thrombectomy
Treatment outcome
