Objective To investigate the relationship of admission hyperglycemia and changes of infarct volume and in-hospital (within 1 week after onset) outcome in elderly patients with acute ischemic stroke after recombinant Tissue Plasminogen Activator (rt-PA) administration. Methods Acute ischemic stroke elderly patients who treated with rt-PA within 3 h of onset were included in the study and were divided into hyperglycemic group and normoglycemic group according to admission blood glucose levels. The recanalization and infarct volume on different time points after onset were evaluated with magnetic resonance scans. The NIHSS scores of different time points were also evaluated and compared in two groups. Results 44 patients were enrolled in the study;24 had admission hyperglycemia. The initial infarct volume did not differ between the normoglycemic and hyperglycemic groups (29.5±56.2 vs 28.3±61.7, P=0.90). However, hyperglycemic patients had higher admission NIHSS scores (17.7±6.6 vs 12.9±6.3, P<0.01). Hyperglycemic group had same recanalization and hemorrhage rate as normoglycemic group at 24 hours after onset. Hyperglycemic patients showed larger stroke volume both at 24h and 7d after onset than that of normoglycemic patients (121.7±101.1vs 68.8±85.4, P=0.03;170.8±163.9 vs 92.5±113.6 P=0.02). Hyperglycemic patients had higher NIHSS scores at 24h and 7d after onset (14.3±6.9 vs. 8.6±5.1, P<0.01; 8.8±7.4 vs 4.3±3.9, P<0.01). Patients of hyperglycemic group showed worse outcome rate at 7d after onset than patients of normoglycemic group (42% vs 15%, P=0.05). Conclusion Admission hyperglycemia did not interfere with the early recanalization and safety of rt-PA thrombolysis, but was associated with in hospital infarct volume expansion and poor outcome in acute ischemic stroke elderly patients.%目的：了解就诊时血糖升高与急性缺血性脑卒中老年患者接受重组组织型纤溶酶原激活剂（rt-PA）溶栓后脑梗死体积变化及院内（发病后1周内）预后的关系。方法发病后3 h接受r t-PA的急性缺血性卒中老年患者，按照就诊血糖分为高血糖组与正常血糖组，采用磁共振评价溶栓各时间点血管再通率、脑梗死体积变化，并评价各时间段的NIHSS评分及预后指标。结果共44人纳入本研究，其中24人分入高血糖组；溶栓即刻高血糖组患者梗死体积与正常血糖患者相比无明显差异[（29.5±56.2） vs （28.3±61.7），P＝0.90]，NIHSS评分明显增高[（17.7±6.6） vs （12.9±6.3），P＜0.01]；高血糖患者溶栓24h后血管再通率与出血转化率相同；发病后24h及1周，高血糖患者脑梗死体积更大[(121.7±101.1) vs （68.8±85.4），P＝0.03；（170.8±163.9） vs （92.5±113.6），P＝0.02]，NIHSS评分更高[（14.3±6.9） vs （8.6±5.1），P＜0.01；（8.8±7.4） vs （4.3±3.9），P＜0.01]，发病后1周，高血糖患者的不良预后的比例比正常血糖者明显升高（42%vs 15%，P＝0.05）。结论就诊时高血糖对脑卒中老年患者rt-PA溶栓血管再通率及安全性无明显影响，高血糖与溶栓后院内梗死延展及预后不良明显相关。
展开▼
