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Neurology：急性缺血性脑卒中后胰岛素抵抗导致功能预后不良

2018-04-03 zhangfan MedSci原创

急性缺血性脑卒中胰岛素抵抗预后
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研究认为急性缺血性脑卒中后胰岛素抵抗与不良功能结果相关，与中风复发或死亡不相关

近日研究人员就急性缺血性脑卒中后胰岛素抵抗与临床结果之间的关系进行了考察。

研究招募了4655名急性缺血性脑卒中患者，患者平均年龄70.3岁，男性占63.5%，住院期间未接受胰岛素治疗。在患者发病后8.3天测量空腹血糖以评估胰岛素抵抗(HOMA-IR)水平。研究终点包括神经功能改善（NIH中风评分改善4分以上）、不良功能结局（3个月 Rankin评分3分以上）以及3个月预后（中风复发及全因死亡）。采用逻辑回归分析考察HOMA-IR得分与预后的关系。

研究发现，HOMA-IR得分与神经功能改善（改善最佳1/5患者vs最差1/5患者OR 0.68）和不良功能结局（功能最差1/5患者vs最佳1/5患者OR 2.02）相关，该相关性在调整糖尿病以及体重指数后仍显著。HOMA-IR得分与3个月内中风复发或死亡不相关，上述相关性在非糖尿病或非肥胖患者中保持不变。不同年龄、性别、脑卒中亚型或卒中严重程度患者中未观察到异质性。

研究认为急性缺血性脑卒中后胰岛素抵抗与不良功能结果相关，与中风复发或死亡不相关。

原始出处：


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    2019-01-14 12498dd9m11暂无昵称

    #缺血性脑卒中后#

    0

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    2019-01-15 waiwai3039

    #卒中后#

    0

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    2018-09-20 yinhl1978

    #Neurol#

    0

  4. 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GetPortalCommentsPageByObjectIdResponse(id=1259382, encodeId=f05b12593822a, content=<a href='/topic/show?id=5679523e201' target=_blank style='color:#2F92EE;'>#急性缺血性脑卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52372, encryptionId=5679523e201, topicName=急性缺血性脑卒中)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1488343, encodeId=c5e414883431c, content=<a href='/topic/show?id=b34f1001e187' target=_blank style='color:#2F92EE;'>#预后不良#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100171, encryptionId=b34f1001e187, topicName=预后不良)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b86b8414062, createdName=caoliehu, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492850, encodeId=7e3014928505a, content=<a href='/topic/show?id=447732948d0' target=_blank style='color:#2F92EE;'>#功能预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32948, encryptionId=447732948d0, topicName=功能预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=728c8977388, createdName=zsyan, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=)]
    2018-05-17 guihongzh

    #缺血性#

    0

  5. 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createdBy=b86b8414062, createdName=caoliehu, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492850, encodeId=7e3014928505a, content=<a href='/topic/show?id=447732948d0' target=_blank style='color:#2F92EE;'>#功能预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32948, encryptionId=447732948d0, topicName=功能预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=728c8977388, createdName=zsyan, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=)]
    2018-08-10 ms7524819409032184

    #缺血性脑#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1807237, encodeId=5ede180e2371e, content=<a href='/topic/show?id=6eade9380cb' target=_blank style='color:#2F92EE;'>#缺血性脑卒中后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79380, encryptionId=6eade9380cb, topicName=缺血性脑卒中后)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b3ad2500191, createdName=12498dd9m11暂无昵称, createdTime=Mon Jan 14 03:57:00 CST 2019, time=2019-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1671334, encodeId=b23c16e1334e6, content=<a href='/topic/show?id=9f4e360191a' target=_blank style='color:#2F92EE;'>#卒中后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36019, encryptionId=9f4e360191a, topicName=卒中后)], attachment=null, authenticateStatus=null, createdAvatar=null, 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createdBy=b86b8414062, createdName=caoliehu, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492850, encodeId=7e3014928505a, content=<a href='/topic/show?id=447732948d0' target=_blank style='color:#2F92EE;'>#功能预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32948, encryptionId=447732948d0, topicName=功能预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=728c8977388, createdName=zsyan, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=)]
    2018-08-19 baoya

    #胰岛#

    0

  7. 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GetPortalCommentsPageByObjectIdResponse(id=1259382, encodeId=f05b12593822a, content=<a href='/topic/show?id=5679523e201' target=_blank style='color:#2F92EE;'>#急性缺血性脑卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52372, encryptionId=5679523e201, topicName=急性缺血性脑卒中)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1488343, encodeId=c5e414883431c, content=<a href='/topic/show?id=b34f1001e187' target=_blank style='color:#2F92EE;'>#预后不良#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100171, encryptionId=b34f1001e187, topicName=预后不良)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b86b8414062, createdName=caoliehu, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492850, encodeId=7e3014928505a, content=<a href='/topic/show?id=447732948d0' target=_blank style='color:#2F92EE;'>#功能预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32948, encryptionId=447732948d0, topicName=功能预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=728c8977388, createdName=zsyan, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=)]
    2018-04-07 张新亮1853311252142e2fm

    好文献.学习了

    0

  8. 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GetPortalCommentsPageByObjectIdResponse(id=1259382, encodeId=f05b12593822a, content=<a href='/topic/show?id=5679523e201' target=_blank style='color:#2F92EE;'>#急性缺血性脑卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52372, encryptionId=5679523e201, topicName=急性缺血性脑卒中)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1488343, encodeId=c5e414883431c, content=<a href='/topic/show?id=b34f1001e187' target=_blank style='color:#2F92EE;'>#预后不良#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100171, encryptionId=b34f1001e187, topicName=预后不良)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b86b8414062, createdName=caoliehu, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492850, encodeId=7e3014928505a, content=<a href='/topic/show?id=447732948d0' target=_blank style='color:#2F92EE;'>#功能预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32948, encryptionId=447732948d0, topicName=功能预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=728c8977388, createdName=zsyan, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=)]
    2018-04-05 snowpeakxu

    #急性缺血性脑卒中#

    0

  9. 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GetPortalCommentsPageByObjectIdResponse(id=1259382, encodeId=f05b12593822a, content=<a href='/topic/show?id=5679523e201' target=_blank style='color:#2F92EE;'>#急性缺血性脑卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52372, encryptionId=5679523e201, topicName=急性缺血性脑卒中)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1488343, encodeId=c5e414883431c, content=<a href='/topic/show?id=b34f1001e187' target=_blank style='color:#2F92EE;'>#预后不良#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100171, encryptionId=b34f1001e187, topicName=预后不良)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b86b8414062, createdName=caoliehu, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492850, encodeId=7e3014928505a, content=<a href='/topic/show?id=447732948d0' target=_blank style='color:#2F92EE;'>#功能预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32948, encryptionId=447732948d0, topicName=功能预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=728c8977388, createdName=zsyan, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=)]
    2018-04-05 caoliehu

    #预后不良#

    0

  10. 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createdBy=b86b8414062, createdName=caoliehu, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492850, encodeId=7e3014928505a, content=<a href='/topic/show?id=447732948d0' target=_blank style='color:#2F92EE;'>#功能预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32948, encryptionId=447732948d0, topicName=功能预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=728c8977388, createdName=zsyan, createdTime=Thu Apr 05 00:57:00 CST 2018, time=2018-04-05, status=1, ipAttribution=)]
    2018-04-05 zsyan

    #功能预后#

    0

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Stroke：血清半乳凝素-3与急性缺血性脑卒中患者不良预后之间的关系！

由此可见，高水平的血清半乳凝素-3与卒中发病后死亡或严重残疾的风险增加独立相关，这表明半乳凝素-3可能在缺血性脑卒中患者预后不良具有预测价值。

JAMA Neurol：急性缺血性脑卒中后再灌注成功可降低脑水肿风险

研究发现，急性缺血性脑卒中后再灌注成功可降低脑水肿风险，成功再灌注与预后改善显著相关

2017 AHA/ASA科学声明：急性缺血性脑卒中静脉阿替普酶溶栓后出血性转化的治疗和结局

2017年11月，美国心脏协会(AHA)联合美国卒中协会(ASA)共同发布了关于急性缺血性脑卒中静脉阿替普酶溶栓后出血性转化的治疗和结局的科学声明。阿替普酶静脉溶栓后症状性颅内出血少见，却是严重并发症，快速诊断并早期纠正凝血障碍仍是主要治疗手段，缺血性卒中需要一步研究保持血脑屏障完整性，而后者立足于抑制基础生化过程。

Stroke：AHA/ASA急性缺血性脑卒中静脉阿替普酶溶栓后出血性转化的治疗与预后的科学声明

2017年12月Stroke杂志刊登了AHA和ASA的科学声明《急性缺血性卒中阿替普酶静脉溶栓后出血转化的治疗和预后》，现在摘录如下。

中国急性缺血性脑卒中中西医急诊诊治专家共识

近年来，我国脑血管疾病发病率一直呈上升趋势，据统计其病死率在2014 年高于心血管、肿瘤和其他疾病。急性缺血性脑卒中（AIS）是各种原因导致的脑组织血液供应障碍，并由此产生缺血缺氧性坏死，进而出现神经功能障碍的一组临床综合征，约占脑卒中的60%～80%。缺血性脑卒中急性期的时间划分目前尚不统一，国内外一般指发病后2 周内。AIS 的诊断和救治强调早期诊断、早期治疗、早期康复和早期预防。随着医学科学

Eur Radiol：急性缺血性脑卒中后再灌注会增加血脑屏障破坏可逆性的几率

介于血液和脑组织之间的对物质通过有选择性阻碍作用的动态界面，由脑的连续毛细血管内皮及其细胞间的紧密连接、完整的基膜、周细胞以及星形胶质细胞脚板围成的神经胶质膜构成，其中内皮是血脑屏障的主要结构。本研究旨在发现有无再灌注的情况下，急性缺血性脑卒中（AIS）血脑屏障通透性（BBBP）的早期改变，以及是否BBBP能够预测临床预后，并将结果发表在Eur Radiol上。