Zhongguo cuzhong zazhi (May 2022)
应激性高血糖比值与急性缺血性卒中患者临床预后的相关性研究Correlation between Stress Hyperglycemia Ratio and Clinical Prognosis of Patients with Acute Ischemic Stroke
Abstract
Objective To investigate the correlation between stress hyperglycemia ratio (SHR) and 90-day clinical prognosis of patients with acute ischemic stroke (AIS). Methods The data of AIS patients who were admitted in Department of Neurology, Yangpu Hospital, Tongji University from May 2016 to October 2020 were retrospectively analyzed. The outcome was assessed by 90-day mRS and composite vascular events (recurrent stroke, myocardial infarction and vascular death). The favorable prognosis was defined as a mRS score of 0-2, and unfavorable prognosis was defined as a mRS score of 3-6 and composite vascular events within 90 days after stroke. SHR was calculated by fasting blood glucose divided by the estimated average blood glucose. The multivariate logistic regression analysis was used to determine whether SHR was an independent influencing factor of the 90-day prognosis. ROC curve was used to evaluate the effect of SHR to predict 90-day prognosis. Spearman correlation was used to analyze the correlation between SHR and clinical factors. Results (1) A total of 1484 patients were included,with the median age of 70 (62-80) years and 948 males (63.9%). The median baseline NIHSS score was 3 (2-7). There were 923 cases (62.2%) in favorable prognosis group and 561 cases (37.8%) in unfavorable prognosis group. (2) Univariate analysis showed that the SHR in favorable prognosis group was significantly lower than that in unfavorable prognosis group [0.82 (0.72-0.95) vs . 0.86 (0.74-1.02), P =0.001]. (3) Multivariate logistic regression analysis showed that compared with the lowest quartile of SHR, the highest quartile was independently associated with the 90-day unfavorable prognosis (OR 2.22, 95%CI 1.26-3.91, P =0.006), which had statistical difference in non-diabetic group in subgroup analysis (OR 2.11, 95%CI 1.19-3.75, P =0.010), and no statistical difference in diabetic group (OR 1.53, 95%CI 0.69-3.42, P =0.298). (4) The area under the ROC curve (C-value) of SHR for predicting 90-day unfavorable prognosis was 0.552 (95%CI 0.526-0.578, P =0.001, the optimal cut-off value was 0.84, the sensitivity was 52.94%, and the specificity was 56.12%); and in non-diabetic subgroup, the C-value was 0.600 (95%CI 0.563-0.637, P <0.001, the optimal cut-off value was 0.87, the sensitivity was 52.48%, and the specificity was 64.97%). (5) Correlation analysis showed that SHR was positively correlated with the baseline NIHSS score (r =0.115, P <0.001), CRP (r =0.079, P =0.002), and white blood cell count (r =0.126, P <0.001), while negatively correlated with platelet count (r =-0.094, P <0.001). Conclusions In AIS patients, elevated SHR was associated with unfavorable functional outcome at 90 days, especially in non-diabetic patients. SHR may be correlated with stroke severity at admission and inflammation. 目的 探讨急性缺血性卒中后应激性高血糖比值（stress hyperglycemia ratio，SHR）与患者发病后90 d临床预后的相关性。方法 回顾性连续分析2016年5月-2020年10月就诊于同济大学附属杨浦医院的急性缺血性卒中患者临床和随访相关资料。以发病后90 d的mRS及复合血管事件（缺血性卒中复发、心肌梗死和血管性原因死亡）发生情况评估临床预后，其中mRS≤2分定义为预后良好，mRS 3～6分或发病后90 d内发生复合血管事件定义为预后不良。SHR由空腹血糖除以糖化血红蛋白估计的平均血糖计算。采用多因素logistic回归分析SHR是否为急性缺血性卒中患者发病后90 d预后的独立影响因素。使用ROC曲线评估SHR预测患者发病后90 d预后的效果。采用Spearman相关性分析SHR与临床因素的相关性。结果 （1）最终纳入1484例患者中，男性948例（63.9%），中位年龄70（62～80）岁，中位NI HSS 3 （2～7）分，其中预后良好组923例（62.2%），预后不良组561例（37.8%）。（2）单因素分析显示，预后良好组患者SHR低于预后不良组［0.82（0.72～0.95）vs . 0.86（0.74～1.02），P =0.001］。（3）多因素logistic回归分析显示，与SHR最低四分位数组相比，最高四分位数组与90 d不良预后风险升高独立相关（OR 2.22，95%CI 1.26～3.91，P =0.006）。亚组分析显示在非糖尿病患者组这一结果同样显著（OR 2.11，95%CI 1.19～3.75，P =0.010），但糖尿病患者组并未发现差异（OR 1.53，95%CI 0.69～3.42，P =0.298）。（4）ROC曲线显示，SHR预测发病后90 d临床不良预后的AUC为0.552（95%CI 0.526～0.578，P =0.001，SHR最佳截断值为0.84，敏感度为52.94%，特异度为56.12%），在非糖尿病患者亚组，其AUC为0.600（95%CI 0.563～0.637，P <0.001，SHR最佳截断值为0.87，敏感度为52.48%，特异度为64.97%）。（5）相关性分析显示，SHR与基线NIHSS（r =0.115，P <0.001）、CRP水平（r =0.079，P =0.002）、白细胞计数（r =0.126，P <0.001）呈正相关，与血小板计数呈负相关（r =-0.094，P<0.001）。结论 对于急性缺血性卒中患者，SHR升高与发病后90 d临床预后不良相关，尤其对非糖尿病患者预测价值更大。SHR增高可能与卒中严重程度及炎症反应具有一定的相关性。应激性高血糖比值和卒中严重程度、炎症反应相关，是急性缺血性卒中患者90 d预后不良的预测因素。
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