Stroke：糖化血红蛋白A1或可有效预测卒中溶栓的出血风险

症状性颅内出血(sICH)是静脉溶栓最急且较严重的并发症，而往往很难预测出血的风险。来自德国的A. Rocco等医生评价了急性卒中溶栓后出血的预测情况，在线发表在2013年5月28日的stroke杂志上。该研究的目的是评估糖化血红蛋白A1(HbA1c)对症状性脑出血的预测价值。研究显示：糖化血红蛋白或可有效预测卒中溶栓的出血风险。

在一项回顾性单中心研究中，共纳入1112例连续登记的静脉溶栓患者。在入院时均有血糖的检测，并在住院期间进行了HbA1c的检查。在入院24小时或神经症状恶化时进行颅脑CT检查。在发病90天时使用改良Rankin评分进行检查。

共有222例(19.9%)患者出现任何形式的出血症状，其中以接受卒中安全实施治疗组定义有43例(3.9%)出现症状性颅内出血，以神经疾病及卒中委员会定义组中有95例(8.5%)；33.2%的患者出现依赖性预后（改良Rankin评分为3到5分）。在单因素分析中，入院时糖尿病病史、HbA1c、血糖及NIHSS评分与以神经疾病及卒中委员会定义任何形式的出血及症状性颅内出血相关，而以接受卒中安全实施治疗组定义评价时只有HbA1c具有相关性。

该研究显示，HbA1c是急性卒中溶栓治疗发生症状性出血的重要预测因素。这些结果显示溶栓后出血或因为长期的血管损伤而不是急性期高血糖所致，因此糖化血红蛋白A1相比血糖浓度或糖尿病病史来说，更能有效预测卒中溶栓治疗后颅内出血的风险。

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.