■确定高HbA1c水平是否与缺血性卒中(IS)患者的短期和长期功能结局相关,以及这种关联是否根据IS亚型和患者年龄而有所不同。
■韩国16家医院或地区卒中中心收治的7380名IS患者的数据,在2017年5月至2019年12月期间,我们从卒中-韩国-国立卫生研究院的临床研究协作机构数据库获得,并进行了回顾性分析.在这些患者中,对4598人进行了为期一年的随访。HbA1c水平分为三组(<5.7,5.7至<6.5%,≥6.5%)。使用改良的Rankin量表在3个月和1年时2至6分定义短期和长期不良功能结局。分别。根据ORG10172急性中风治疗试验(TOAST)分类对IS亚型进行分类。
■所有患者在3个月时HbA1c较高(≥6.5%)与不良功能结局之间存在关联(3个月;OR,1.299,95%CI1.098,1.535,一年期;或,1.181,95%CI0.952,1.465)。按年龄分组时,在年轻的成人组(<65岁)中观察到的3个月和1年后的关联,但不在65岁及以上的组中(3个月;<65岁OR,1.467,95%CI1.112,1.936,≥65岁或,1.220,95%CI0.987,1.507,相互作用p=0.038,一年;<65年OR,1.622,95%CI1.101,2.388,≥65岁或,1.010,95%CI0.778,1.312,相互作用p=0.018)。在年轻的成年人群体中,较高的HbA1c水平与小血管闭塞亚型患者的短期和长期功能丧失有关(3个月;OR,2.337,95CI1.334,4.095,一年;或,3.004,95%CI1.301,6.938)。然而,在其他TOAST亚型患者中,高HbA1c水平不会增加不良结局的风险,无论发病年龄。
高HbA1c水平会增加IS发病后短期和长期功能不良结局的风险。然而,这种关联因卒中亚型和年龄而异.因此,卒中前期高血糖,HbA1c反映,可能是缺血性卒中后预后不良的重要预测因子,尤其是中青年。
UNASSIGNED: To determine whether high HbA1c levels are related to short-and long-term functional outcomes in patients with ischemic stroke (IS) and whether this association differs according to the IS subtype and the patient\'s age.
UNASSIGNED: The data of 7,380 IS patients admitted to 16 hospitals or regional stroke centers in South-Korea, between May 2017 and December 2019, were obtained from the Clinical Research Collaboration for Stroke-Korea-National Institute of Health database and retrospectively analyzed. Among these patients, 4,598 were followed-up for one-year. The HbA1c levels were classified into three groups (<5.7, 5.7 to <6.5%, ≥6.5%). Short-and long-term poor functional outcomes were defined using the modified Rankin Scale score of 2 to 6 at three-months and one-year, respectively. IS subtypes were categorized according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification.
UNASSIGNED: There was an association between higher HbA1c (≥6.5%) and poor functional outcomes at three-months in all patients (three-months; OR, 1.299, 95% CI 1.098, 1.535, one-year; OR, 1.181, 95% CI 0.952, 1.465). When grouped by age, the associations after both 3 months and 1 year observed in younger adult group (<65 years), but not in group aged 65 years and older (three-months; <65 years OR, 1.467, 95% CI 1.112, 1.936, ≥65 years OR, 1.220, 95% CI 0.987, 1.507, p for interaction = 0.038, one-year; <65 years OR, 1.622, 95% CI 1.101, 2.388, ≥65 years OR, 1.010, 95% CI 0.778, 1.312, p for interaction = 0.018). Among younger adult group, the higher HbA1c level was related to short-and long-term functional loss in patients with the small vessel occlusion subtype (three-months; OR, 2.337, 95%CI 1.334, 4.095, one-year; OR, 3.004, 95% CI 1.301, 6.938). However, in patients with other TOAST subtypes, a high HbA1c level did not increase the risk of poor outcomes, regardless of the age of onset.
UNASSIGNED: High HbA1c levels increase the risk of short-and long-term poor functional outcomes after IS onset. However, this association differs according to stroke subtype and age. Thus, pre-stroke hyperglycemia, reflected by HbA1c, may be a significant predictor for a poor prognosis after ischemic stroke, particular in young- and middle-aged adults.