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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >The Effect of Hyperglycemia on Infarct Growth after Reperfusion: An Analysis of the DEFUSE 3 trial
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The Effect of Hyperglycemia on Infarct Growth after Reperfusion: An Analysis of the DEFUSE 3 trial

机译：高血糖对再灌注后梗死生长的影响：解除术3试验的分析

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Background and purpose: Brain infarct growth, despite successful reperfusion, decreases the likelihood of good functional outcome after ischemic stroke. In patients undergoing reperfusion, admission glucose is associated with poor outcome but the effect of glucose level on infarct growth is not well studied. Materials and Methods: This is a secondary analysis of the DEFUSE 3 trial. The primary predictor was baseline glucose level and the primary outcome is the change of the ischemic core volume from the baseline to 24-hour follow-up imaging (core), transformed as a cube root to reduce right skew. We included DEFUSE 3 patients who were randomized to endovascular therapy, had perfusion imaging data at baseline, an MRI at 24 hours, and who achieved TICI 2b or 3. Linear regression models, both unadjusted and adjusted, were fit to the primary outcome and all models included the baseline core volume as a covariate to normalize score. Results: We identified 62 patients who met our inclusion criteria. The mean age was 68.1 +/- 13.1 (years), 48.4% (30/62) were men, and the median (IQR) cube root of Delta core was 2.8 (2.0-3.8) mL. There was an association between baseline glucose level and normalized Delta core in unadjusted analysis (beta coefficient 0.010, p = 0.01) and after adjusting for potential confounders (beta coefficient 0.008, p = 0.03). Conclusion: In acute ischemic stroke patients with large vessel occlusion undergoing successful endovascular reperfusion, baseline hyperglycemia is associated with infarction growth. Further study is needed to establish potential neuroprotective benefits of aggressive glycemic control prior to and after reperfusion.
机译：背景和目的：尽管再灌注成功，但脑梗死的增长降低了缺血性卒中后功能恢复良好的可能性。在接受再灌注的患者中，入院时的血糖与不良预后相关，但血糖水平对梗死生长的影响尚未得到很好的研究。材料和方法：这是对DEFUSE 3试验的二次分析。主要预测因素是基线血糖水平，主要结果是缺血核心体积从基线到24小时随访成像（core）的变化，转化为立方根以减少右偏。我们纳入了3名患者，他们被随机分为血管内治疗组，在基线检查时有灌注成像数据，在24小时进行了MRI检查，并且达到了TICI 2b或3。未经调整和调整的线性回归模型均适用于主要结果，所有模型均将基线核心体积作为协变量，以使得分正常化。结果：我们确定了62名符合纳入标准的患者。平均年龄为68.1+/-13.1（岁），48.4%（30/62）为男性，δ核的中值（IQR）立方根为2.8（2.0-3.8）mL。在未经调整的分析（β系数0.010，p=0.01）和校正潜在混杂因素（β系数0.008，p=0.03）中，基线血糖水平和标准化δ核之间存在关联。结论：在大血管闭塞的急性缺血性卒中患者中，成功进行血管内再灌注后，基线高血糖与梗死增长相关。需要进一步研究，以确定再灌注前后积极血糖控制的潜在神经保护益处。

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