medigraphic.com
ISSN 2225-4676 (Digital)

2012, Número 2

<< Anterior Siguiente >>

Rev Cubana Neurol Neurocir 2012; 2 (2)


Hiperglicemia post–ictus

Fernández CO, Buergo ZMÁ, López JM

Idioma: Español
Referencias bibliográficas: 47
Paginas: 144-149
Archivo PDF: 238.99 Kb.


RESUMEN

Objetivos: Revisar las evidencias disponibles sobre la frecuencia y mecanismos de producción de la hiperglicemia postictus (HPI), así como aquellas que relacionan la HPI con el riesgo de evolución desfavorable y la eficacia de alternativas de tratamiento para esta entidad.
Desarrollo: Entre el 43% y el 68% de los pacientes que sufren un ictus tienen un aumento en los niveles de glicemia. Del 16% al 24% de éstos no son diabéticos conocidos. La gran mayoría de estos pacientes tienen una regulación anormal de la glucosa, 16,4% reciben un nuevo diagnóstico de diabetes mellitus, y el 23,1% tienen una PTG alterada. La HPI tiene dos picos: uno en las primeras ocho horas y otro entre el tercer y quinto día. La HPI se asocia a muerte y evolución desfavorable, sobre todo la hiperglicemia persistente; además, aumenta el riesgo de transformación hemorrágica tras la trombólisis. El punto de corte para iniciar tratamiento con insulina no está claro, estudios han definido 7,2 mmol/L o 8,7 mmol/L; sin embargo, las guías clínicas sugieren 10 mmol/L debido al riesgo de hipoglicemia con estrategias más agresivas.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol. 2007;6:182–7.

  2. Bonita R, Beaglehole R. Stroke prevention in poor countries. Time for action. Stroke. 2007;38:2871–2.

  3. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006; 3:E442.

  4. Buergo Zuaznábar MA, Fernández concepción O, y col. Guías de Practicas clínicas par el ictus. ECIMED: Habana, 2008.

  5. Fernández Concepción O, Buergo Zuaznabar MA. Necesidad de cambios organizativos en el Sistema Nacional de Salud para la atención del ictus. Rev Cubana Salud Pública. 2008;34(2).

  6. Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycaemia and prognosis of stroke in nondiabetic and diabetic patients. A systematic overview. Stroke. 2001; 32: 2426–32.

  7. Poppe AY, Majumdar SR, Jeerakathil T, Ghali W, Buchan AM, Hill MD; On Behalf Of The Canadian Alteplase For Stroke Effectiveness Study (CASES) Investigators. Admission Hyperglycemia Predicts a Worse Outcome in Stroke Patients Treated With Intravenous Thrombolysis. Diabetes Care. 2009; 32:617–22.

  8. Gray CS, Scott JF, French JM, Alberti KG, O’Connell JE. Prevalence and prediction of unrecognised diabetes mellitus and impaired glucose tolerance following acute stroke. Age Ageing. 2004;3:71–7.

  9. Fuentes B, Díez–Tejedor E, Castillo J, Da´valos A, Gil–Nunez A, Vivancos J, Egido J; on behalf of the Stroke Project of the Cerebrovascular Disease Study of the Spanish Society of Neurology: Prognostic value of glucose levels in acute stroke outcome: GLIA Study (abstract). Stroke. 2006;37:625.

  10. Matz K, Keresztes K, Tatschl C, Nowotny M, Dachenhausen A, Brainin M. Disorders of Glucose Metabolism in Acute Stroke Patients. An underrecognized problem. Diabetes Care 2006;29:792–7.

  11. Quinn TJ, Lees KR. Hyperglycaemia in Acute Stroke –To Treat or Not to Treat. Cerebrovasc Dis. 2009;27(Suppl 1):148–55.

  12. Allport L, Baird T, Butcher K, et al: Frequency and temporal profile of post stroke hyperglycaemia using continuous glucose monitoring. Diabetes Care. 2006;29:1839–44.

  13. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2003; 26(Suppl 1):5–20.

  14. Scott JF, Robinson GM, O’Connell JE, Alberti KG, Gray CS. Prevalence of admission hyperglycaemia across clinical subtypes of acute stroke. Lancet. 1999; 353: 376–7.

  15. Tracey F, Stout RW. Hyperglycemia in the acute phase of stroke and stress response. Stroke. 1994;25:424–5.

  16. Counsell C, McDowall M, Dennis M. Hyperglycaemia after scute stroke. Other models find that hyperglycaemia is not independent predictor. BMJ. 1997;314:810–1.

  17. Allport LE, Butcher KS, Baird TA, MacGregor L, Desmond PM, Tress BM, et al. Insular cortical ischemia is independently associated with acute stress hyperglycemia. Stroke. 2004; 35:1886–91.

  18. Gray CS, Hildreth AJ, Alberti GKMM, O’Connell JE; on behalf of the GIST Collaboration. Poststroke hyperglycemia. Natural history and immediate management. Stroke. 2004;35:122–6.

  19. Yong M, Kaste M. Dynamic of Hyperglycemia as a Predictor of Stroke Outcome in the ECASS–II Trial. Stroke. 2008; 39:2749–55.

  20. Alvarez–Sabin J, Molina CA, Montaner J, Arenillas JF, Huertas R, Ribo M, et al. Effects of admission hyperglycemia on stroke outcome in reperfused tissue plasminogen activator–treated patients. Stroke. 2003;34:1235–41.

  21. Bruno A, Levine SR, Frankel MR, Brott TG, Lin Y, Tilley BC, e al; the NINDS rt–PA Stroke Study Group. Admission glucose level and clinical outcomes in the NINDS rt–PA Trial. Neurology. 2002;59:669–74.

  22. Baird TA, Parsons MW, Phanh T, et al: Persistent post stroke hyperglycaemia is associated with infarct expansion and worse clinical outcome. Stroke 2003;34:2208–14.

  23. Kushner M, Nencini P, Reivich M, et al: Relation of hyperglycaemia early in ischaemic brain infarction to cerebral anatomy, metabolism and clinical outcome. Ann Neurol. 1990;28:129–35.

  24. Anderson RE, Tan WK, Mertin HS, Meyer FB. Effects of glucose and PaO2 modulation on cortical intracellular acidosis, NADH redox state and infarction in the ischaemic penumbra. Stroke. 1999;30:160–70.

  25. Nazir FS, Alem M, Small M, Connell JM, Lees KR, Walters MR, et al. Blunted response to systemic nitric oxide synthase inhibition in the cerebral circulation of patients with type 2 diabetes. Diabetes Med. 2006;23:398–402.

  26. Dandona P, James IM, Newbury PA, Wolard Ml, Beckett AG. Cerebral blood flow in diabetes mellitus: evidence of abnormal cerebrovascular reactivity. BMJ. 1978;2:325–6.

  27. Shechter M, Merz CN, Paul–Labrador MJ, Kaul S. Blood glucose and platelet–dependent thrombosis in patients with coronary artery disease. J Am Col Cardiol. 2000; 35:300–7.

  28. Kerman WN, Inzucchi SE, Viscoli CM, Brass LM, Bravata DM, Horwitz RI. Insulin resistance and risk for stroke. Neurology. 2002; 59:809–15.

  29. Kerman WN, Inzucchi SE, Viscoli CM, et al. Impaired insulin sensitivity among nondiabetic patients with a recent TIA or ischemic stroke. Neurology. 2003;60:1447–51.

  30. Song EC, Chu K, Jeong SW, Jung KH, Kim SH, Kim M, et al. Hyperglycaemia exacerbates brain oedema and perihaematomal cell death after intracerebral haemorrhage. Stroke. 2003;34:2215–20.

  31. Bruno A, Levnie SR, Frankel MR, Brott TG, Kwiatkowski TG, Fineberg SE; for the NINDS rt–PA stroke study group. Admission glucose level and clinical outcomes in the NINDS rt–PA stroke trial. Neurology. 2002;59:669–74.

  32. Lilienfield DE, Vlahov D, Tenney JH, McLaughlin JS. Obesity and diabetes as risk factors for postoperative wound infections after cardiac surgery. Am J Infect Cont. 1998;16:3–6.

  33. Ortega–Casarrubios MA, Fuentes B, San Jose B, Martinez P, Diez–Tejedor E. Influence of previous diagnosis of diabetes mellitus on stroke severity and in hospital outcome in acute cerebral infarction. Neurologia. 2007;22:426–33.

  34. Fuentes B, Castillo J, San Jose B, Leira R, Serena J, Vivancos J, et al; for the Stroke Project of the Cerebrovascular Diseases Study Group, Spanish Society of Neurology. The Prognostic Value of Capillary Glucose Levels in Acute Stroke. The GLycemia in Acute Stroke. (GLIAS) Study. Stroke 2009;40:562–8.

  35. Langhorne P, Pollock A; for the Stroke Unit Trialists Collaboration: What are the components of effective stroke unit care. Age Ageing. 2002; 31: 365–371.

  36. Pittas AG, Siegel RD, Lau J. Insulin therapy for critically ill hospitalized patients: a meta–analysis of randomized controlled trials. Arch Intern Med. 2004; 164:2005–11.

  37. Gray CS, Hildreth AJ, Sandercock PA, O’Connell JE, Johnston DE, Cartlidge NEF, et al; for the GIST Trialists Collaboration. Glucose–potassium–insulin infusions in the management of post–stroke hyperglycaemia: the UK Glucose Insulin in Stroke Trial (GIST–UK). Lancet Neurol. 2007;6:397–406.

  38. Gentile NT, Seftchick MW, Huynh T, Kruus LK, Gaughan J. Decreased mortality by normalizing blood glucose after acute ischemic stroke. Acad Emerg Med. 2006;13:174–80.

  39. Walters MR, Weir CJ, Lees K. A randomised, controlled pilot study to investigate the potential benefit of intervention with insulin in hyperglycaemic acute ischaemic stroke patients. Cerebrovasc Dis. 2006;22:116–22.

  40. Bruno A, Saha C, Williams LS, Shankar R. IV insulin during acute cerebral infarction in diabetic patients. Neurology. 2004;62:1441–2.

  41. Bruno A, Kent TA, Coull BM, et al: Treatment of Hyperglycaemia in Ischaemic Stroke (THIS): a randomized pilot trial. Stroke. 2008;39:384–9.

  42. Johnston KC, Hall CE, Kissela BM, Bleck TP, Conaway MR; for the GRASP Investigators Glucose Regulation in Acute Stroke Patients (GRASP) Trial. A Randomized Pilot Trial. Stroke. 2009;40:3804–9.

  43. Kreisel SH, Berschin UM, Hammes HP, Leweling H, Bertsch T, Hennerici MG, et al. Pragmatic Management of Hyperglycaemia in Acute Ischaemic Stroke: Safety and Feasibility of Intensive Intravenous Insulin Treatment. Cerebrovasc Dis. 2009;27:167–75.

  44. The NICE–SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360: 1283–97.

  45. Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP Jr, Selby JV. Hypoglycemic Episodes and Risk of Dementia in Older Patients With Type 2 Diabetes Mellitus. JAMA. 2009;301:1565–72.

  46. The European Stroke Organisation (ESO) Executive Committee and ESO Writing Committee: Guidelines for the Management of Ischaemic Stroke and Transient Ischaemic Attack 2008. Cerebrovasc Dis. 2008; 25: 457–507.

  47. Adams HP, del Zoppa G, Alberts MJ, et al; for the American Heart Association, American Stroke Association Stroke Council. Guidelines for the early management of adults with ischaemic stroke. Stroke. 2007;38:1655–711.




2020     |     www.medigraphic.com