Stroke：HbA1c为溶栓后脑内出血预测因子

　　德国一项研究表明，糖化血红蛋白A1C（HbA1c）为急性卒中溶栓后症状性脑内出血（sICH）的重要预测因子。论文5月28日在线发表于《卒中》（Stroke）。

　　此项研究共纳入1112例接受溶栓治疗的序贯性急性卒中患者。入院时测定基线血糖，并在住院期间确定HbA1c。24小时后或神经功能恶化时进行第二次头颅CT检查。利用改良Rankin量表评估90天转归。

　　结果显示，共有222例（19.9%）发生出血。依据卒中治疗安全实施（SITS）和德国国家神经疾病和卒中研究所（NINDS）定义分别有43例（3.9%）和95例（8.5%）患者发生sICH；33.2%的患者伴有依赖性转归（改良Rankin量表评分3～5分）。单变量分析显示，糖尿病病史、HbA1c、血糖、入院时NIHSS评分与各种出血和sICH具有相关性。多变量分析显示，依据NINDS标准时NIHSS评分、糖尿病病史和HbA1c为sICH的预测因子，依据SITS标准时仅HbA1c为预测因子。

Glycosylated Hemoglobin A1 Predicts Risk for Symptomatic Hemorrhage After Thrombolysis for Acute Stroke
Background and Purpose
Symptomatic intracerebral hemorrhage (sICH) is the most feared acute complication after intravenous thrombolysis. The aim of this study was to determine the predictive value of parameters of glycosylated hemoglobin A1 (HbA1c) on sICH.
Methods
In a retrospective single center series, 1112 consecutive patients treated with thrombolysis were studied. Baseline blood glucose was obtained at admission. HbA1c was determined within hospital stay. A second head computed tomography was obtained after 24 hours or when neurological worsening occurred. Modified Rankin Scale was used to assess outcome at 90 days.
Results
A total of 222 patients (19.9%) had any hemorrhage; 43 of those had sICH (3.9%) per Safe Implementation of Treatments in Stroke definition and 95 (8.5%) per National Institute of Neurological Disorders and Stroke definition; 33.2% of patients had a dependent outcome (modified Rankin Scale score 3–5). In univariate analysis history of diabetes mellitus, HbA1c, blood glucose, and National Institute of Health Stroke Scale score on admission were associated with any hemorrhage and sICH. In multivariate analysis National Institute of Health Stroke Scale score, a history of diabetes mellitus, and HbA1c were predictors of sICH per National Institute of Neurological Disorders and Stroke, and only HbA1c when Safe Implementation of Treatments in Stroke criteria were used.
Conclusions
In our study, HbA1c turns out to be an important predictor of sICH after thrombolysis for acute stroke. These results suggest that hemorrhage after thrombolysis may be a consequence of long-term vascular injury rather than of acute hyperglycemia, and that HbA1c may be a better predictor than acute blood glucose or a history of diabetes mellitus.