Correlation Between Blood Glucose Variability and Early Therapeutic Effects After Intravenous Thrombolysis With Alteplase and Levels of Serum Inflammatory Factors in Patients With Acute Ischemic Stroke

So you described something, but DID NOTHING USEFUL THAT WILL HELP STROKE PATIENTS RECOVER. Why the fuck are you in stroke anyway?

Correlation Between Blood Glucose Variability and Early Therapeutic Effects After Intravenous Thrombolysis With Alteplase and Levels of Serum Inflammatory Factors in Patients With Acute Ischemic Stroke

Yun Cai^1,2†, Hongtao Zhang^1†, Qiang Li² and Peilan Zhang^3*

• ¹Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
• ²Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
• ³Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China

Objective: To investigate the effects of blood glucose variability on early therapeutic effects after intravenous thrombolysis with alteplase and the levels of serum inflammatory factors in patients with acute ischemic stroke (AIS).

Methods: We enrolled AIS patients who received intravenous thrombolysis within 4.5 h of the onset of symptoms. Clinical data, including the National Institutes of Health Stroke Scale (NIHSS), glycosylated hemoglobin, mean blood glucose, standard deviation of blood glucose, mean amplitude of glycemic excursion, mean variation coefficient of blood glucose, interleukin-6 (IL-6), active matrix metalloproteinase-9 (MMP-9), tumor necrosis factor α (TNF-α), and hypersensitive C-reactive protein (hs-CRP) levels, were compared between a group who showed improvement (the improvement group) and a group who did not show improvement (the non-improvement group). Relevant factors for early neurological improvement after thrombolysis with alteplase were analyzed by using multivariate logistic regression models. A Pearson linear correlation analysis was also performed on blood glucose variation and inflammatory factor levels within the two groups.

Results: A total of 146 patients were included, 63 of which had early symptom improvement (43.15%). The diabetes ratio, atrial fibrillation ratio, baseline NHISS score, random blood glucose at admission, and glycosylated hemoglobin of patients in the improvement group were significantly lower than those in the non-improvement group (P < 0.05 in all cases). The mean blood glucose, standard deviation of blood glucose, mean amplitude of glycemic excursion, and mean blood glucose variation coefficients of patients in the improvement group were significantly lower than those in the non-improvement group (P < 0.05). Serum inflammatory factor levels, including IL-6, MMP-9, TNF-α and hs-CRP, were significantly lower in patients in the improvement group compared to patients in the non-improvement group (P < 0.05). Multivariate logistic regression analysis showed that baseline NIHSS scores (OR = 1.28, 95% CI = 1.05–1.62, P = 0.02), glycosylated hemoglobin scores (OR = 2.57, 95% CI = 1.78–3.98, P = 0.0005), diabetes (OR = 13.10, 95% CI = 1.63~131.45, P = 0.021), the mean amplitude of glycemic excursion (OR = 2.98, 95% CI = 1.92–5.00, P < 0.0001), and the mean variation coefficient of blood glucose (OR = 1.40, 95% CI = 1.26–1.60, P = 0.0078) were significantly correlated with early symptom improvement after thrombolysis. Pearson linear correlation analysis showed that the standard deviation of blood glucose, mean amplitude of glycemic excursion, and the mean variation coefficient of blood glucose were significantly positively correlated with IL-6, MMP-9, TNF-α and hs-CRP levels (P < 0.01).

Conclusions: Blood glucose variability is correlated with early neurological improvement after intravenous thrombolysis with alteplase in AIS patients. With the increase of blood glucose fluctuation range, the inflammatory response is enhanced, which affects the prognosis of patients.

Stroke is the disease with the highest incidence, disability, and mortality in China, with ischemic stroke accounting for 70% of disease burden. At present, the most effective treatment is intravenous thrombolytic therapy with recombinant tissue plasminogen activators (rt-PA) at early stages of the disease (<4.5 h) (1). Early improvement in neurological function after thrombolytic therapy is a marker of vascular recanalization and is independently predictive of good prognoses at 3 months. However, the efficacy of intravenous thrombolytic therapy is not always satisfactory. This may be due to many factors. Blood glucose and blood glucose variability are important risk factors for cardiovascular and cerebrovascular diseases, and blood glucose variation can induce the occurrence or aggravation of inflammatory responses. Recent studies have confirmed that blood glucose variability is an important prognostic factor that can independently predict death in critically ill patients. However, there is still no consensus about the influence of blood glucose variability on the effects of early thrombolytic therapy and inflammatory responses in AIS patients. Here, we studied AIS patients that were treated with intravenous thrombolytic therapy with alteplase. While strictly controlling for blood glucose levels and reducing the incidence of hypoglycemia, we evaluated the correlation between blood glucose variation levels, the early treatment effects of intravenous thrombolytic therapy with alteplase, and levels of serum inflammatory factors. We hope to guide effective blood glucose-based interventions, and to improve the therapeutic effects of intravenous thrombolysis in patients experiencing AIS.

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