Correlation Between Glucose Variability With Acute Ischemic Stroke TOAST Classification

Objective:Glucose variability closely related to prognosis of critically ill patients neurology, but on acute ischemic stroke TOAST classification subtypes correlated with glucose variability has not been reported. In this study, the incidence within 24 hours of admission,143 patients with acute ischemic stroke patients TOAST classification, and observe the patient’s blood glucose variability, combined with the prognosis of patients in order to understand:(1) acute ischemic stroke patients NEW-TOAST subtype distribution of each type. (2) the relationship between the various subtypes and glycemic variability; (3) factors glycemic variability (4) glucose variability with recent ischemic stroke prognosis. Provide clinical evidence for the importance and management of patients with acute ischemic stroke glucose variability, and promote recovery of neurological function and improve the prognosis.Methods Consecutive August 2013-2014 August at the Second Affiliated Hospital of Kunming Medical University stem three inpatient treatment, and the onset to admission time≤24 hours, or a stroke again, but first take care of themselves before the disease acute ischemic cerebrovascular stroke patients with 143 cases,84 cases were male and 80 female, aged 27 to 91 years, mean 66.5±12.0 years. Diagnosis of acute ischemic stroke and cerebrovascular disease are in line with the Fourth National Conference revised diagnostic criteria and confirmed by CT or MIR.Exclusion criteria:(1) with acute cerebral infarction in patients with cerebral hemorrhage and subarachnoid hemorrhage;(2) significant liver dysfunction or heart failure patients in critical condition;(3) The recent history of surgery and trauma patients;(4) recently taking hormones or immunosuppressive agents in patients with:(5) Before the disease caused by any reason, can not take care of patients’ daily lives;(6) do not want the line uncooperative patient’s glucose monitoring.All patients were admitted to hospital after the acquisition of gender, age, medical history, clinical signs, laboratory tests and laboratory examinations and other information.24-hour ambulatory blood glucose monitoring. According to history, the results of clinical manifestations and laboratory examinations of patients, all patients with acute ischemic stroke by NEW-TOAST classification criteria are divided into five subtypes:atherosclerosis, thrombosis (Atherothrombosis, AT), small artery occlusion stroke stroke (small artery occlusion, SAO), cardioembolic stroke (cardio-aortic embolism, CE), to determine the cause of other reasons (stroke of other determined etiology, SOE) and cryptogenic stroke (stroke of undetermined etiology, SUE).According to the US National Institutes of Health Stroke Scale (NIH Stoke Scale, NIHSS), based on the evaluation of neurologic impairment scale admission neurologic impairment, and divided according to the degree of neurological deficit mild defect group, the group of moderate defects, severe defects groups. Statistical analysis was performed using SPSS 17.0, measurement data for normal distribution with ±s said Univariate analysis was performed using t test; measurement data does not conform to the normal distribution is represented by the median and interquartile. Univariate analysis was performed using Wilcoxon test. Count data expressed as a percentage, univariate analysis using the x2 test or Fisher’s exact precision, multivariate analysis using logistic regression analysis (backward method), the use of technology when the dummy variable arguments for multi-classification. P<0.05 was considered statistically significant.Result 1.143 cases of patients with NEW-TOAST classification proportion of each type:atherosclerosis, thrombosis (AT) 53 patients (37.0%), small artery occlusive stroke (SAO) 71 patients (49.6%), stroke cardioembolic stroke (CE) 17 patients (11.7%), due to other reasons determined (SOE) 1 patients (0.7%), unexplained stroke (SUE) 1 patients (0.7%).2. Normal and abnormal glucose variability range of groups from baseline glucose variability range of group3.The study enrolled 143 patients with acute ischemic stroke patients,85 cases (59.4%) abnormal glucose variability. Univariate analysis showed that age, history of diabetes, NIHSS score is a risk factor for acute ischemic stroke merger of glucose variability (P<0.05).4 Multivariate Logistic regression analysis showed that:admission NIHSS score higher in patients with abnormal glucose variability is 2.464 times the normal blood glucose variability (95% CI,1.992-3.159); obese patients with abnormal blood glucose variability is normal variability of 1.798 fold (95% CI,1.004-3.096); glucose variability in patients with hypertension often is 1.27 times the normal blood glucose variability (95% CI, 1.058-1.890). This shows that the severity of stroke, obesity, hypertension is an independent factor affecting glycemic variability.5.Multivariate analysis (Table 5) shows:adjustment for sex, age, admission NIHSS score, hypertension, diabetes, dyslipidemia, smoking, alcohol consumption, type of stroke and other factors that may affect later, abnormal glucose variability (SD> 1.04mmol/L) is an independent risk factor for acute ischemic stroke poor prognosis. Compared with normal glucose variability (SD<1.04mmol/L), abnormal poor prognosis group is 2.821 times the normal group (95% CI,1.880-4.233). Admission NIHSS score, age were independent risk factors for poor prognosis.6.NEW-TOAST classification subtypes glucose variability comparison:three groups X2=7.075, P=0.029 (P<0.05) difference between the groups the same failure. Subtypes twenty-two comparison shows:AT and SAO, X2=10.073, P=0.002, AT and CE, X2=3.760, P=0.052; SAO with CE, X2= 0.073, P=0.782; SOE, SUE due to relatively small number of cases no no sense, not contrast. AT each subgroup variability of blood glucose is greater than the difference between SAO and CE groups.Conclusion 1. in patients with acute ischemic stroke etiology NEW-TOAST classification to the high proportion of SAO.2.TOAST classification of each subgroup AT group is greater than the difference between glucose variability SAO and CE groups.3. The severity of stroke, obesity, high blood pressure were independent predictors of glycemic variability.4. large glycemic variability (SD> 1.04mmol/L) is an independent risk factor for acute ischemic stroke poor prognosis.