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基线葡萄糖升高和桥梁与直接EVT中的出血并发症

Peng Lu¹, Rundong Chen², Meihua Huyan³

¹Department of Neurosurgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

|January 29, 2026

概括

入院高血糖症增加了急性缺血性中风 (AIS) 患者的出血风险,这些患者接受了内血管血栓切除术 (EVT). 在患有严重高血糖症 (>11.1 mmol/L) 的患者中,桥梁疗法比直接EVT带来更高的辅酶血瘤风险.

科学领域:

神经学神经学
心血管医学心血管医学
内血管外科血管内血管外科

背景情况:

入院时的高血糖与急性缺血性中风 (AIS) 中出血风险增加有关.
在患有高血糖症的AIS患者中,桥梁疗法 (alteplase + EVT) 和直接EVT之间的比较出血风险尚未确定.

研究的目的:

调查接受EVT的AIS患者的入院葡萄糖水平和出血并发症之间的关联.
根据葡萄糖水平来确定桥梁治疗和直接EVT之间的出血风险是否不同.

主要方法:

对DIRECT-MT试验的特异分析 (n=627) 包括AIS患者在内的患者有资格接受alteplase.
评估基线葡萄糖水平和对出血结果的评估 (出血转变,脑膜血瘤,症状性内出血).
后勤回归和受限立方线模型用于分析葡萄糖-出血关联和治疗相互作用.

主要成果:

高血糖水平与更高的出血转化 (HT) 几率相关 (aOR为1.168每1mmol/L).
一个显著的相互作用显示,桥梁疗法与直接EVT在葡萄糖水平>11.1 mmol/L时增加了出血风险.
在>11.1 mmol/L小组中,桥梁疗法显示了对子酶血瘤 (PH) 风险的增加 (OR 4.84),而在≤11.1 mmol/L时没有观察到过度风险.

结论:

在接受EVT治疗的AIS患者中,入院高血糖与出血并发症的增加相关.
对于明显高血糖 (>11.1 mmol/L) 的患者,桥梁疗法与直接EVT相比,伴随着帕伦基马出血瘤的风险更高.
这些发现表明,在严重高血糖症患者中,应该考虑直接EVT,同时监测和管理葡萄糖.

关键词:

急性缺血性中风是一次急性缺血性中风.桥梁治疗疗法桥梁治疗血管内血栓切除术是指血管内血栓切除术.血液变化的出血转化过高血糖症的发生.

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