ISC2019:SHINE研究:强化静脉血糖控制未改善卒中结局

2019-02-09 国际循环编辑部 国际循环

2月6日 ,国际卒中(ISC 2019)大会开幕式后重磅发布了SHINE研究(The Stroke Hyperglycemia Insulin Network Effort)最新结果。该研究表明,在改善卒中康复方面,强化静脉注射(IV)胰岛素治疗并不优于标准胰岛素注射。

美国-夏威夷时间, 2月6日 ,国际卒中(ISC 2019)大会开幕式后重磅发布了SHINE研究(The Stroke Hyperglycemia Insulin Network Effort)最新结果。该研究表明,在改善卒中康复方面,强化静脉注射(IV)胰岛素治疗并不优于标准胰岛素注射。

高血糖或血糖增加在急性缺血性卒中患者中很常见,临床数据显示,高血糖与急性脑缺血患者预后较差相关,且重度高血糖增加缺血性脑损伤。然而,降低血糖能否改善患者预后尚不清楚。全世界都在争论控制这类患者血糖水平的最佳方法。

SHINE研究在一项多中心随机对照试验中评估使用持续静脉胰岛素输注与标准皮下注射胰岛素相比,长达72小时血糖控制的有效性和安全性。纳入标准:年龄在18岁或以上;临床诊断为缺血性卒中的患者;2型糖尿病,血糖> 110 mg/dl或未知的糖尿病,血糖≥150 mg/dl;基线NIHSS评分3~22。主要排除标准:I型糖尿病;既往存在混杂因素;肾透析;无法遵循协议,包括需胰岛素输注和不能随访。强化治疗组:胰岛素滴注 ,血糖目标80~130 mg/dl;标准治疗组:SQ胰岛素q 6 h,血糖目标<180 mg/dl。



与使用胰岛素注射的标准血糖(葡萄糖)对照相比,静脉注射胰岛素并未改善卒中结局,回答了世界范围内关于控制卒中患者血糖最佳方法的争论。

初步结果显示:通过静脉注射胰岛素进行强化血糖治疗,将血糖降低至80~130 mg/dl的目标,与使用胰岛素注射将血糖降低至180 mg/dl以下的标准血糖控制相比,在90天时未改善患者功能结局。第4中期分析因无效停止,招募计划最大患者数的82%(1151/1400),未超出安全界值。



此外,强化血糖治疗增加患者发生极低血糖(低血糖)风险,并且需消耗更多资源,例如增加护理人员的监督。

神经学教授、医学博士Karen C. Johnston指出,这项研究为临床指导控制急性缺血性卒中和高血糖患者的血糖水平提供明确证据。

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    2019-09-01 fusion
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    2019-07-03 xue8602
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    2019-02-11 yankaienglish
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    2019-02-10 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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