自发性脑出血发作前血糖水平和脑出血预后的相关性
|
摘要
目的探索自发性脑出血发作前血糖水平与脑出血患者预后风险之间的关系,进而研究对于自发性脑出血患者预后风险率的预测价值。方法选取2013年7月至2015年7月的SICH患者157例为研究对象,记录基线资料包括发病年龄、体重指数(BMI)、性别、吸烟、饮酒、家族患病史、治疗方式、高血脂、高血压、发作前血糖水平、冠心病、入院收缩压、入院舒张压、糖尿病及NIHSS评分。对所有患者进行为期2年的随访,在随访期间发生不良预后的患者定义为不良预后组,病情无恶化者定义为预后良好组,单因素分析显示影响自发性脑出血患者预后风险率的因素; Cox比例风险模型进一步评价存在统计学意义的所有因素对患者预后的影响程度;运用ROC曲线分析发作前血糖水平和NIHSS评分预测自发性脑出血患者预后风险的敏感性和特异性。结果单因素分析显示患者年龄、入院收缩压(P=0. 041)、发作前血糖水平(P=0. 037)及NIHSS评分(P=0. 001)明显影响SICH患者治疗后的预后情况能影响自发性脑出血患者预后风险率的大小,差异均有统计学意义(P <0. 05)。多因素Cox比例风险模型结果显示患者发作前血糖水平(P=0. 037)及NIHSS评分(P=0. 001)对患者预后有显著影响,二者相比,发作前血糖水平对患者预后有显著影响(RR=2. 683); ROC曲线下发作前血糖水平在ROC曲线下的AUC为0. 707(95%置信区间:0. 624～0. 789),最佳诊断点为11. 55,其预测的敏感性和特异性分别为74. 30%,70. 65%; NIHSS评分在ROC曲线下的AUC为0. 546(95%置信区间:0. 452～0. 641),最佳诊断点为10,其预测的敏感性和特异性分别为63. 21%,55. 37%。结论发作前血糖水平对自发性脑出血患者预后风险率的大小有较好的预测能力,有望作为自发性脑出血患者的常规评估指标广泛应用于临床。
Objective To investigate the correlation between blood glucose levels before spontaneous cerebral hemorrhage and prognosis of patients with cerebral hemorrhage,and to explore the predictive value of NIHSS score and serum resistin blood glucose levels in the adverse prognosis of patients with spontaneous cerebral hemorrhage. Methods A total of157 patients who were diagnosed as spontaneous cerebral hemorrhage and treated in our hospital from September 2013 to September 2015 were enrolled in the study. The baseline data including patient's age and sex,BMI,smoking,drinking,family history,treatment modes,high cholesterol,high blood pressure,blood sugar levels,coronary heart disease,systolic blood pressure,diastolic blood pressure,diabetes and NIHSS scores were analyzed. All the patients were followed up for 2 years,and the patients with adverse outcomes during follow up were regarded as poor prognosis group,however,the patients without aggravation of disease condition were regarded as good prognosis group. Univariate analysis was used to analyze the prognostic factors affecting the prognosis of patients with spontaneous cerebral hemorrhage. In addition Cox proportional hazard model was used to evaluate the influencing factors on prognosis of patients,and ROCcurve was used to analyze the blood sugar levels before admission. Moreover the sensitivity and specificity of NIHSS scores in predicting prognosis of patients with cerebral hemorrhage were analyzed. Results The univariate analysis showed that patient's age,admission systolic blood pressure,blood glucose level before spontaneous cerebral hemorrhage and NIHSS scores could significantly affect the prognosis of patients with spontaneous cerebral hemorrhage( P < 0. 05). Multivariate Cox proportional hazard model showed that patients' blood glucose levels before spontaneous cerebral hemorrhage and NIHSS score had significant effects on the prognosis of the patients,especially the blood glucose levels( RR = 2. 683). Moreover the AUC under ROC curve of blood glucose levels before spontaneous cerebral hemorrhage was 0. 707( 95% confidence interval: 0. 624～0. 789),the best diagnosis point was 11. 55,and the sensitivity and specificity were 74. 30%,70. 65%,respectively. However the AUC of NIHSS score was 0. 546,best diagnosis point was 10,and sensitivity and specificity were 63. 21%,55. 37%,respectively. Conclusion The blood glucose level of patients before spontaneous cerebral hemorrhage has better predictive value in evaluating the prognosis of patients with spontaneous cerebral hemorrhage,which is expected to be one of the routine indexes for patients with spontaneous cerebral hemorrhage.
Objective To investigate the correlation between blood glucose levels before spontaneous cerebral hemorrhage and prognosis of patients with cerebral hemorrhage,and to explore the predictive value of NIHSS score and serum resistin blood glucose levels in the adverse prognosis of patients with spontaneous cerebral hemorrhage. Methods A total of157 patients who were diagnosed as spontaneous cerebral hemorrhage and treated in our hospital from September 2013 to September 2015 were enrolled in the study. The baseline data including patient's age and sex,BMI,smoking,drinking,family history,treatment modes,high cholesterol,high blood pressure,blood sugar levels,coronary heart disease,systolic blood pressure,diastolic blood pressure,diabetes and NIHSS scores were analyzed. All the patients were followed up for 2 years,and the patients with adverse outcomes during follow up were regarded as poor prognosis group,however,the patients without aggravation of disease condition were regarded as good prognosis group. Univariate analysis was used to analyze the prognostic factors affecting the prognosis of patients with spontaneous cerebral hemorrhage. In addition Cox proportional hazard model was used to evaluate the influencing factors on prognosis of patients,and ROCcurve was used to analyze the blood sugar levels before admission. Moreover the sensitivity and specificity of NIHSS scores in predicting prognosis of patients with cerebral hemorrhage were analyzed. Results The univariate analysis showed that patient's age,admission systolic blood pressure,blood glucose level before spontaneous cerebral hemorrhage and NIHSS scores could significantly affect the prognosis of patients with spontaneous cerebral hemorrhage( P < 0. 05). Multivariate Cox proportional hazard model showed that patients' blood glucose levels before spontaneous cerebral hemorrhage and NIHSS score had significant effects on the prognosis of the patients,especially the blood glucose levels( RR = 2. 683). Moreover the AUC under ROC curve of blood glucose levels before spontaneous cerebral hemorrhage was 0. 707( 95% confidence interval: 0. 624～0. 789),the best diagnosis point was 11. 55,and the sensitivity and specificity were 74. 30%,70. 65%,respectively. However the AUC of NIHSS score was 0. 546,best diagnosis point was 10,and sensitivity and specificity were 63. 21%,55. 37%,respectively. Conclusion The blood glucose level of patients before spontaneous cerebral hemorrhage has better predictive value in evaluating the prognosis of patients with spontaneous cerebral hemorrhage,which is expected to be one of the routine indexes for patients with spontaneous cerebral hemorrhage.
引文
1向玲,昌盛,胡如海,等.脑出血患者入院时血糖、血压、心肌酶、D-二聚体与疾病严重程度及预后的关系研究.中国急救复苏与灾害医学杂志,2017,12:123-126.
2 Ren TH,Yuan B,Yang TC,et al. Impact of admission hyperglycemia on stroke-associated pneumoniain acute cerebral hemorrhage:a retrospective observational study. Open Journal of Emergency Medicine,2015,3:1-8.
3 孔杰,戎金花,颜骏,等.影响青年人自发性脑出血预后的相关因素分析.临床神经外科杂志,2016,13:231-233.
4 Godoy DA,Pi1ero GR,Svampa S,et al. Hyperglycemia and short-term outcome in patients with spontaneous intracerebral hemorrhage.Neurocritical Care,2008,9:217-229.
5 Huttner HB,Kiphuth IC,Teuber L,et al. Neuroendocrine changes in patients with spontaneous supratentorialintracerebral hemorrhage.Neurocritical Care,2013,18:39-44.
6 方媛,游潮,张世洪,等.自发性脑出血急性期高血糖与预后的关系.中国脑血管病杂志,2011,8:172-176.
7 张运周.自发性脑出血患者急性期的影响预后因素及临床评分.中华老年心脑血管病杂志,2016,18:561-563.
8 饶明俐,王文志,黄如训.中国脑血管病防治指南,2007.
9 刘倩绫,罗效萍,许金明,等.自发性脑出血患者的血糖分析.中华神经外科疾病研究杂志,2014,13:79-80.
10 张广慧,何明利,徐艳,等.糖化血红蛋白与脑出血患者预后的关系.中华神经医学杂志,2015,14:1018-1022.
11 Liu X. Determination of the cause of hyperglycemia in acute cerebral hemorrhage by detecting the serum levels of fructose and glucose.Diabetes New World,2016,89:2749-2752.
12 白雪浩,李建辉,杨继军,等.自发性脑出血患者急性期血糖水平与神经功能缺损和预后的相关性研究.实用临床医药杂志,2015,19:170-171.
13 Zhang C,Chen Z,Zeng J,et al. Influence of variable therapies on the neural functional prognosis in patients with acute cerebral hemorrhage merging hyperglycemia. Chinese Journal of Practical Nervous Diseases,2016.
14 Guo X,Li H,Zhang Z,et al. Hyperglycemia and mortality risk in patients with primary intracerebral hemorrhage:a meta-analysis.Molecular Neurobiology,2016,53:2269-2275.
15 孟艳举,王路,王献清,等.青年自发性脑出血的病因及临床特点分析.中华神经外科疾病研究杂志,2016,15:490-492.
16 张长风,陈志远,曾家良,等.不同治疗方案对急性脑出血合并高血糖患者神经功能预后的影响.中国实用神经疾病杂志,2016,19:14-16.
2 Ren TH,Yuan B,Yang TC,et al. Impact of admission hyperglycemia on stroke-associated pneumoniain acute cerebral hemorrhage:a retrospective observational study. Open Journal of Emergency Medicine,2015,3:1-8.
3 孔杰,戎金花,颜骏,等.影响青年人自发性脑出血预后的相关因素分析.临床神经外科杂志,2016,13:231-233.
4 Godoy DA,Pi1ero GR,Svampa S,et al. Hyperglycemia and short-term outcome in patients with spontaneous intracerebral hemorrhage.Neurocritical Care,2008,9:217-229.
5 Huttner HB,Kiphuth IC,Teuber L,et al. Neuroendocrine changes in patients with spontaneous supratentorialintracerebral hemorrhage.Neurocritical Care,2013,18:39-44.
6 方媛,游潮,张世洪,等.自发性脑出血急性期高血糖与预后的关系.中国脑血管病杂志,2011,8:172-176.
7 张运周.自发性脑出血患者急性期的影响预后因素及临床评分.中华老年心脑血管病杂志,2016,18:561-563.
8 饶明俐,王文志,黄如训.中国脑血管病防治指南,2007.
9 刘倩绫,罗效萍,许金明,等.自发性脑出血患者的血糖分析.中华神经外科疾病研究杂志,2014,13:79-80.
10 张广慧,何明利,徐艳,等.糖化血红蛋白与脑出血患者预后的关系.中华神经医学杂志,2015,14:1018-1022.
11 Liu X. Determination of the cause of hyperglycemia in acute cerebral hemorrhage by detecting the serum levels of fructose and glucose.Diabetes New World,2016,89:2749-2752.
12 白雪浩,李建辉,杨继军,等.自发性脑出血患者急性期血糖水平与神经功能缺损和预后的相关性研究.实用临床医药杂志,2015,19:170-171.
13 Zhang C,Chen Z,Zeng J,et al. Influence of variable therapies on the neural functional prognosis in patients with acute cerebral hemorrhage merging hyperglycemia. Chinese Journal of Practical Nervous Diseases,2016.
14 Guo X,Li H,Zhang Z,et al. Hyperglycemia and mortality risk in patients with primary intracerebral hemorrhage:a meta-analysis.Molecular Neurobiology,2016,53:2269-2275.
15 孟艳举,王路,王献清,等.青年自发性脑出血的病因及临床特点分析.中华神经外科疾病研究杂志,2016,15:490-492.
16 张长风,陈志远,曾家良,等.不同治疗方案对急性脑出血合并高血糖患者神经功能预后的影响.中国实用神经疾病杂志,2016,19:14-16.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |