| Stroke has gradually become the leading cause of death worldwide,with high morbidity,high mortality and disability.Spontaneous intracerebral hemorrhage(sICH)is the second largest type of stroke,the incidence rate accounts for approximately 10-15%of all stroke patients in western countries,in Chinese population the incidence may reach up to 18.8-47.6%.According to the cause of the disease,intracerebral hemorrhage(ICH)is usually divided into primary and secondary cerebral hemorrhage.ICH is dangerous,the condition changes quickly,more than 70%patients with early hematoma expansion or involving the ventricle,and it is liable to develop into a devastating event in 20%-30%patients within three months of onset,and a considerable proportion of survivors have poor outcomes,leading to a heavy economy and social burden.In 2003,China's statistics showed that the direct medical expenses of ICH were 13.72 billion yuan per year.ICH has sudden clinical symptoms,usually occurs in the activity,often manifested as headache,nausea,vomiting,varying degrees of disturbance of consciousness and limb paralysis.Early hematoma enlargement is the leading cause of poor prognosis in patients with ICH.The relationship between early hematoma enlargement and age,sex,blood pressure,blood glucose,coronary heart disease,alcohol and tobacco history,coagulation abnormalities,coma scores,mannitol use still reported differently.Hyperglycemia can be divided into diabetes mellitus and prediabetes.Diabetes mellitus has become one of the most common chronic non-communicable diseases.The number of patients and prevalence of diabetes mellitus in China have increased significantly.The prevalence of adult diabetes in China is as high as 11.6%,and the number of patients with diabetes ranks first in the world.In China,type 2 diabetes mainly accounted for more than 90%.Diabetes can increase the risk of cardiovascular disease and certain types of cancer and the risk of death,the mechanism of which include hyperglycemia,hypercoagulability,hyperinsulinemia,insulin resistance and oxidative stress,etc.Prediabetes refers to fasting plasma glucose and(or)oral glucose tolerance test(OGTT)2h plasma glucose(2hPG)increased but did not meet the diagnostic criteria for diabetes,including impaired fasting glucose(IFG)and(or)impaired glucose tolerance(IGT).Prediabetes is considered as a marker or watershed,such as the emergence of a future cardiovascular disease,diabetes,microvascular disease and the risk of cancer and dementia increased.Hyperglycemia is closely related to acute stroke.As early as 1976,it was found that patients with acute stroke who had no history of diabetes also had hyperglycemia.Studies have confirmed that acute hyperglycemia is an independent risk factor for ischemic stroke and subarachnoid hemorrhage.Hyperglycemia is also associated with hemorrhagic transformation of ischemic stroke and hemorrhagic transformation after thrombolytic therapy.The effect of hyperglycemia on the outcomes of sICH has not been well-investigated.Clinical observational studies have shown that the cerebral hemorrhage patients with hyperglycemia had higher mortality and poorer prognosis,other studies found the elevated blood glucose only to be a stress response of ICH.Prospective cohort study was used in this study,the consecutive patients diagnosed with sICH,who were referred to the department of neurology in Nanjing First Hospital between March 2006 and May 2010 were enrolled.Random plasma glucose level at admission and fasting plasma glucose level on the following day were measured using glucose-oxidase method using an automated biochemical analyzer.Neurological severity was assessed using the National Institutes of Health Stroke Scale(NIHSS).The functional outcomes were evaluated using modified Rankin Score(mRS)at three months after onset of sICH.we investigated the potential association between the plasma glucose levels and the 90-day prognosis in patients with acute sICH.PART 1 The association between admission random glucose and severity of disease and 90-day prognosis in patients with spontaneous intracerebral hemorrhageObjective:To evaluate the potential association between the admission random blood glucose and severity of disease and 90-day prognosis in patients with spontaneous intracerebral hemorrhage(sICH).Methods:Patients with a well-defined diagnosis of sICH admitted within 24h of onset were included.Hyperglycemia was defined as a random plasma glucose>10 mmol/L.Neurological severity was assessed using the National Institutes of Health Stroke Scale(NIHSS).Functional outcomes were evaluated using modified Rankin Score(mRS)at three months after onset,divided into good prognosis group(mRS<2)and poor prognosis group(mRS>3,including death or severe disability).The severity of disease and the prognosis of 90-day were compared.Results:228 consecutive adult patients with ICH were prospectively enrolled.198(86.8%)patients were found to be euglycemic and 30(13.2%)hyperglycemic.A total of 26(11.4%)patients were diabetic,compared to the euglycemic group,there were more patients with a history of diabetes in the hyperglycemic group(p<0.001).According to the mRS values at 90 days after onset,96(45.3%)patients had a poor outcome(mRS ?3).On Spearman's correlation analysis,the admission random plasma glucose levels showed a positive correlation with the NIHSS values(r=0.183,P=0.009),and had no significant association with the mRS values at 90 days after onset(r=0.108,P=0.146).On logistic regression analysis,age(OR:1.053;95%CI:1.015-1.092)and NIHSS values at admission(OR:1.251;95%CI:1.141-1.371)were independently associated with poor outcomes.Conclusion:Diabetic patients are more prone to hyperglycemia in the acute stage of ICH.Random hyperglycemia was associated with neurological severity of sICH,but not with 90-day outcomes.Age and NIHSS values at admission were independently associated with 90-day poor outcomes.PART 2 The association between fasting plasma glucose and severity of disease and 90-day prognosis in patients with spontaneous intracerebral hemorrhageObjective:To evaluate the potential association between the fasting plasma glucose and severity of disease and 90-day prognosis in patients with spontaneous intracerebral hemorrhage(sICH).Methods:228 Patients with a well-defined diagnosis of sICH admitted within 24h of onset were included.Hyperglycemia was defined as a fasting plasma glucose>7 mmol/L.Neurological severity was assessed using the National Institutes of Health Stroke Scale(NIHSS).Functional outcomes were evaluated using modified Rankin Score(mRS)at three months after onset,divided into good prognosis group(mRS<2)and poor prognosis group(mRS>3,including death or severe disability).The severity of disease and the prognosis of 90-day were compared.Results:228 consecutive adult patients were prospectively enrolled.According to the fasting plasma glucose levels,there were 169(74.1%)euglycemic and 59(25.9%)hyperglycemic patients.A total of 26(11.4%)patients were diabetic,compared to the euglycemic group,there were more patients with a history of diabetes in the hyperglycemic group(p<0.001).According to the mRS values at 90 days after onset,96(45.3%)patients had a poor outcome(mRS ?3).On Spearman's correlation analysis,the admission random plasma glucose levels showed a positive correlation with the NIHSS values(r=0.133,P=0.045),and had no significant association with the mRS values at 90 days after onset(r=0.116,P=0.098).On logistic regression analyses,age(OR:1.070;95%CI:1.033-1.107)and NIHSS values at admission(OR:1.165;95%CI:1.083-1.253)were independently associated with poor outcomes.Conclusion:Diabetic patients are more prone to hyperglycemia in the acute stage of ICH.Higher fasting glucose level was associated with neurological severity of sICH,but not with 90-day outcomes.Age and NIHSS values at admission were independently associated with 90-day poor outcomes.Base on the above study,the novel parts of our research include:1.Investigating the relationship between the random blood glucose levels and the severity of disease and the 90-day prognosis in patients with spontaneous intracerebral hemorrhageBy observing the relationship between admission blood glucose levels and the NIHSS score and the 90-day prognosis,investigate the influence of random blood glucose on the severity of ICH and the potential influence factors of the 90-day outcomes in patients with spontaneous intracerebral hemorrhage.2.Investigating the relationship between fasting plasma glucose levels and the severity of disease and the 90-day prognosis in patients with spontaneous intracerebral hemorrhageBy observing the relationship between fasting plasma glucose levels and the NIHSS score and the 90-day prognosis,investigate the influence of fasting plasma glucose on the severity of ICH and the potential influence factors of the 90-day outcomes in patients with spontaneous intracerebral hemorrhage. |
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