Türk Beyin Damar Hast Derg. 2012; 18(3): 72-76 | DOI: 10.5505/tbdhd.2012.21931

The effects of temporary hyperglycemia on the prognosis of stroke in patients with acute ischaemýc stroke

Soner Kýlýç¹, Murat Gültekin¹, Ferhan Soyuer², Kürþad Ünlühizarcý³, Ali Soyuer^4
1Kayseri Education And Investigation Hospital Neurology Clinic, Kayseri
²Esciyes University Halil Bayraktar Vocational School Of Health Services
³Erciyes University Faculty Of Medicine Department Of Internal Medicine, Kayseri
⁴Erciyes Kartal Private Hospital Neurology Clinic, Kayseri

OBJECTIVE: In this study, frequency of temporary hyperglycemia and effects of the hyperglycemia on the severity and prognosis of stroke were examined in patients with acute ischaemic stroke.
METHODS: One hundred patients, who applied for acute ischaemic stroke and met the inclusion criteria, were included in the study. Patients were diveded into three groups: normoglycemic, temporary hyperglycemic and diabetes mellitus (DM), according to the baseline blood glucose, fasting blood glucose, oral glucose tolerance test (OGTT) test and HbA1c value. These groups’ National Institue of Stroke Scale (NIHSS), Fugl–Meyer (FM) and Functional Independence Measure (FIM) scores were measured at baseline and at the 3rd month of the follow up; then, these data were compared in terms of the severity and prognosis of stroke. In addition, according to the fasting blood glucose, hyperglycemic and normoglycemic patients becoming permanent diabetics were evaluated. ANOVA, Paired t test and Mann-Whitney U tests were used in the statistical analyses.
RESULTS: Of the patients 52 were normoglycemic, 21 were hyperglycemic and 27 were diabetic. At the 3rd month of the follow up, 28 patients died. Three patients with temporary hyperglycemia became permanent DM. At baseline, severity of stroke as measured by NIHSS, FM and FIM scores was lower, which was statistically significant (p<0.05), in patients with normoglycemia than in those with hyperglycemia or DM. The severity of stroke was not significantly different among hyperglycemic and diabetic patients (p>0.05). Each of the three groups showed significant improvements at the 3rd month after stroke (p<0.05). Normoglycemia group showed the more improvement than diabetic group.
CONCLUSION: In this study, it was concluded that temporary hyperglycemia was not infrequent in patients with ischaemic stroke, and that all forms of hyperglycemia played negative role in the severity and prognosis of stroke. It was determined that follow up of temporary hyperglycemia was important for secondary care of these patients.

Keywords: Ischaemic stroke, temporary hyperglycemia, prognosis

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Akut iskemik inmeli hastalarda geçici hipergliseminin inme prognozu üzerine etkileri

Soner Kýlýç¹, Murat Gültekin¹, Ferhan Soyuer², Kürþad Ünlühizarcý³, Ali Soyuer^4
1Kayseri Eðitim Ve Araþtýrma Hastanesi Nöroloji Servisi, Kayseri
²Erciyes Üniversitesi Halil Bayraktar Saðlýk Hizmetleri Meslek Yüksek Okulu, Kayseri
³Erciyes Üniversitesi Týp Fakültesi Ýç Hastalýklarý Anabilim Dalý, Kayseri
⁴Özel Erciyes Kartal Hastanesi Nöroloji Servisi, Kayseri

AMAÇ: Bu çalýþmada akut iskemik inmede geçici hipergliseminin sýklýðý, hipergliseminin inme þiddeti ve inme prognozu üzerine olan etkileri incelenmiþtir.
YÖNTEMLER: Çalýþmaya akut iskemik inme nedeniyle baþvuran ve çalýþmaya alýnma kriterlerini dolduran 100 hasta dahil edildi. Hastalar geliþ kan þekeri, açlýk kan þekeri, oral glukoz tolerans testi (OGTT) ve HbA1c deðerine göre normoglisemik, geçici hiperglisemik ve diyabetes mellitus (DM) olmak üzere üç gruba ayrýldý. Bu hastalarýn ilk baþvuruda ve takiplerinin üçüncü ayýnda NIHSS (National Institue of Stroke Scale), FM (Fugl–Meyer) ve FIM (Fonksiyonel Baðýmsýzlýk Skalasý) skorlarý belirlenerek inmenin þiddeti ve inme prognozu yönünden karþýlaþtýrýlmalarý yapýldý. Ayrýca hiperglisemik ve normoglisemik olan hastalarýn üçüncü aydaki açlýk kan sekerine göre, kalýcý DM’ye dönüþümü incelendi. Analiz için ANOVA, Paired t resti, ve Mann-Whitney U testi kullanýldý.
BULGULAR: Hastalarýn 52’si normoglisemik, 21’i geçici hiperglisemik, 27’si diyabetik olarak deðerlendirildi. Takiplerinin üçüncü ayýnda 28 hasta eksitus olmuþtu. Geçici hiperglisemili üç hastada daha sonra kalýcý DM geliþti. Hastalarýn ilk baþvuruda ölçülen NIHSS, FM ve FIM deðerleri ile belirlenen inme þiddeti normoglisemik hastalarda, geçici hiperglisemik ve diyabetik hastalara oranla daha düþük tespit edildi (p<0.05). Geçici hiperglisemik ve diyabetik hastalar arasýnda inme þiddeti arasýnda anlamlý fark yoktu (p>0.05). Her üç grup da inmenin üçüncü ayýnda anlamlý derecede iyileþme gösterdi (p<0.05). Normoglisemik grupta iyileþme en belirgin iken DM’li grupta en az iyileþme görüldü.
SONUÇ: Bu çalýþmada geçici hipergliseminin, iskemik inmeli hastalarýn önemli bir kýsmýný oluþturduðu ve hipergliseminin ne þekilde olursa olsun inmenin þiddeti ve prognozu üzerinde olumsuz rol oynadýðý sonucuna varýlmýþtýr. Ýskemik inmeli hastalarýn sekonder korunmasýnda geçici hiperglisemi takibinin önemli olduðu tespit edilmiþtir.

Anahtar Kelimeler: Ýskemik inme, geçici hiperglisemi, prognoz

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