应激性血糖升高比值对预测溶栓后早期神经功能改善的临床价值*

doi:10.3969/j.issn.1671-2587.2023.02.018

临床输血与检验 ›› 2023, Vol. 25 ›› Issue (2): 249-253.DOI: 10.3969/j.issn.1671-2587.2023.02.018

应激性血糖升高比值对预测溶栓后早期神经功能改善的临床价值^*

浦卉, 黄雨馨, 浦春, 汪凯

241001 芜湖市第二人民医院神经内科（浦卉）; 皖南医学院检验学院（黄雨馨,浦春）; 安徽医科大学第一附属医院神经内科（汪凯）

收稿日期:2023-02-10 发布日期:2023-04-25
通讯作者: 汪凯,主任医师,博士,主要从事神经心理学方向研究,（E-mail）wangkai1964@126.com。
作者简介:浦卉,主要从事神经病学相关研究,（E-mail）623538205@qq.com。
基金资助:
*本课题受国家级大学生创新创业训练计划（№．201710368022）资助

Clinical Value of Stress Hyperglycemia Ratio in Predicting Early Neurological Improvement after Thrombolysis

PU Hui, HUANG Yu-xin, PU Chun, et al

Department of Neurology, the Second People's Hospital of Wuhu, Wuhu 241001

Received:2023-02-10 Published:2023-04-25

摘要/Abstract

摘要： 目的分别使用溶栓前随机血糖（RBG）及入院后首次清晨空腹血糖（FBG）同糖化血红蛋白的比值计算应激性血糖升高比值（SHR）,评估SHR与接受重组组织型纤溶酶原激活剂（r-tPA）静脉溶栓的急性缺血性卒中（AIS）患者溶栓后早期神经功能改善（ENI）的相关性。方法分析85例使用r-tPA静脉溶栓治疗的AIS患者的临床资料。SHR1定义为[RBG （mmol/L）]/[HbA1c（%）],SHR2定义为[FBG（mmol/L）]/[HbA1c（%）],分析SHR与ENI的关系。结果单因素分析显示ENI组SHR2中位数为0.87,低于无ENI组中位数1.03（Z=-3.012,P<0.05）。两组间SHR1差异无统计学意义。按患者有无糖尿病分组,无糖尿病患者SHR2预测溶栓后ENI的AUC为0.674,最佳诊断界值为0.9,灵敏度85.0%,特异度57.1%。结论 SHR有望成为溶栓后ENI的预测指标。

关键词: 急性缺血性脑卒中, 应激性血糖升高比值, 静脉溶栓, 早期神经功能改善, 空腹血糖

Abstract: Objective We calculated the stress hyperglycemia ratio (SHR) using pre-thrombolysis random blood glucose (RBG) and fasting blood glucose (FBG) to glycosylated hemoglobin on the first morning after admission to assess the association of SHR with early neurological improvement (ENI) in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis with recombinant tissue plasminogen activator (r-tPA). Methods The clinical data of 85 AIS patients treated with intravenous thrombolysis with r-tPA were analyzed. SHR1 was defined as [RBG (mmol/L)]/[HbA1c(%)], and SHR2 as [FBG (mmol/L)]/[HbA1c(%)]. The relationship between SHR and ENI was analyzed. Results Univariate analysis showed that the median SHR2 of the ENI group was 0.87, lower than that of the non-ENI group, which was 1.03 (Z=-3.012,P<0.05). There was no significant difference in SHR1 between the two groups. In patients without diabetes, the AUC of ENI was 0.674, the optimal diagnostic threshold was 0.9, the sensitivity was 85%, and the specificity was 57.1%. Conclusion SHR promises to be a predictor of ENI after thrombolysis.

Key words: Acute ischemic stroke, Stress hyperglycemia ratio, Intravenous thrombolysis, Early neurological improvement, Fasting blood glucose

中图分类号:

R743

浦卉, 黄雨馨, 浦春, 汪凯. 应激性血糖升高比值对预测溶栓后早期神经功能改善的临床价值^*[J]. 临床输血与检验, 2023, 25(2): 249-253.

PU Hui, HUANG Yu-xin, PU Chun, et al. Clinical Value of Stress Hyperglycemia Ratio in Predicting Early Neurological Improvement after Thrombolysis[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2023, 25(2): 249-253.

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应激性血糖升高比值对预测溶栓后早期神经功能改善的临床价值^*

Clinical Value of Stress Hyperglycemia Ratio in Predicting Early Neurological Improvement after Thrombolysis

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