Hyperglycemia and outcomes of patients with ischemic stroke after reperfusion therapy / 国际脑血管病杂志

ABSTRACT

Hyperglycemia is considered to be a predictor of death, poor functional outcome, symptomatic intracerebral hemorrhage, and increased infarct volume in patients with acute ischemic stroke. Many studies have used parameters such as standard deviation, coefficient of variation, blood glucose level, stress hyperglycemia ratio, and glucose/glycated hemoglobin ratio to express hyperglycemia, and then study the relationship between hyperglycemia and stroke outcome. In patients with stroke receiving intravenous thrombolysis, hyperglycemia is closely associated with symptomatic intracerebral hemorrhage, poor neurological outcome, and lower vascular recanalization rate. In patients with stroke undergoing endovascular mechanical thrombectomy, hyperglycemia is closely associated with poor long-term outcome, increased mortality, and increased infarct volume. However, whether hyperglycemia will affect the effect of reperfusion therapy in acute ischemic stroke remains controversial. The possible mechanisms of hyperglycemia leading to poor outcomes after reperfusion therapy in patients with ischemic stroke include inhibition of vasodilation, reduction of plasma fibrinolytic activity, destruction of the blood-brain barrier, promotion of oxidative stress, and reduction of ischemic penumbra volume. Studies have shown that for stroke patients with hyperglycemia, intensive blood glucose control does not bring significant benefits. Therefore, the blood glucose control program of patients with acute ischemic stroke and hyperglycemia needs further study and discussion.