Buradasınız

Anasayfa » Content

Akut Stroku Takiben Stres Hormon ve Kan Glikoz Cevabının Mortalite ve Morbidite Üzerine Etkileri

Effects of stress hormone and blood glucose response following acute stroke on mortality and morbidity

Journal Name:

  • İnönü Üniversitesi Tıp Fakültesi Dergisi

Publication Year:

  • 1997

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
We studied the relation between reactive hyperglycemia, stress hormone response, and prognosis in 40 patients following an acute stroke. The median age of the patients was 60 (range: 20-80) years. Twenty two patients were men. All patients were seen in the first 24 hour after the onset of symptoms. No subject was known to be diabetic and no one had a glycosylated hemoglobin content above the upper limit of normal. Patients were followed up until death or 21 days following their stroke. They were assessed clinically at days 0, 1, 7, 14, and 21. The outcome for each patient was assigned as good (n=19) or poor (n=21). The subjects were also classified as alive (n=29) or dead (n=11) at the 21st day. Blood samples were taken after fasting, for the determination of serum glucose, insülin, glucagon, and cortisol concentrations on days 0, 1, 2, 3, 7, 14, and 21. For all 40 patients, a significant relation was found between the serum glucose concentration and prognosis (p<0.001) and the serum glucose concentration decreased in time (p<0.001). There was also a significant relation between serum glucose concentration and survival (p<0.001). High glucagon (p<0.001) and cortisol (p<0.001) concentrations were related to poor prognosis. Additionally, high glucagon (p<0.01) and cortisol (p<0.001) concentrations were detected in the patients who died. Hyperglycemia following a stroke probably reflects the intensity of the stress hormone response. We suggested that hyperglycemia is a predictor of poor prognosis in patients with stroke. [Journal of Turgut Özal Medical Center 1997;4(1):40-46]
Bookmark/Search this post with
Abstract (Original Language): 
Akut strok'u takip eden reaktif hiperglisemi, stres hormon cevabı ve prognoz arasındaki ilişki 40 hastada çalışıldı. Hastaların ortalama yaşı 60 'dı (20-80 yaşlar arası); 22 hasta erkekti. Tüm hastalar semptomların başlangıcından itibaren 24 saat geçmemek şartıyla görüldü. Hiç bir hasta diyabetik olarak bilinmiyordu ve normal seviyelerin üstünde glikozile hemoglobin değerine sahip değildi. Hastalar strok'u izleyen 21 günlük süre ya da ölümlerine kadar izlendi. Klinik olarak 0., 1., 7., 14. ve 21. günlerde değerlendirildiler. Prognoz her hasta için iyi (n=19) veya kötü (n=21) olarak belirlendi. Vakalar, bu süre zarfında ölenler (n=ll) ve yaşayanlar (n=29) olarak da sınıflandırıldı. Kan örnekleri hasta aç iken kan glikoz, insülin, glukagon ve kortizol konsantrasyonlarını tayin için 0., 1., 2., 3., 7., 14. ve 21. günlerde alındı. 40 hastanın tamamında kan glikoz konsantrasyonu ile prognoz arasında anlamlı bir ilişki bulundu(p<0.001) ve kan glikoz konsantrasyonunun zamanla azaldığı gözlendi (p<0.001). Aynı zamanda kan glikoz konsantrasyonu ve hayatta kalma arasında da anlamlı bir ilişki vardı (p<0.001). Yüksek glukogan (p<0.001) ve kortizol (p<0.001) konsantrasyonları kötü prognozla ilişkiliydi. Ölen hastalarda da yüksek glukagon (p<0.01) ve kortizol (p<0.001) konsantrasyonları vardı. Strok'u izleyen hiperglisemi muhtemelen stres hormon cevabının şiddetini yansıtmaktadır. Biz hipergliseminin strok'lu hastalarda kötü prognozun öncü bir işaretçisi olduğunu düşünüyoruz. [Turgut Özal Tıp Merkezi Dergisi 1997;4(1):40-46]
FULL TEXT (PDF): 
PDF icon arastirmax-akut-stroku-takiben-stres-hormon-kan-glikoz-cevabinin-mortalite-morbidite-uzerine-etkileri.pdf
  • 1
40-46
  • Turkish

REFERENCES

References: 

1. Pulsinelli WA, Levy DE, Sigsbee B, et al. Increased damage after ischemic stroke in patients with or without established diabetes mellitus. Am J Med 1983;74:540-4.
2. Woo E, Chan YW, Yu YL, et al. Admission glucose level in relation to mortality and morbidity in 252 stroke patients.
Stroke 1988;19:185-91.
3. Fullerton KJ, Mackenzie G, Stout RW. Prognostic indices in stroke. QJ Med 1988; 66:147-62.
4. Courten-Myers G, Myers RE, Schoolfield L. Hyperglycemia enlarges infarct size in cerebrovascular occlusion in cats. Stroke 1988;19:623-30.
5. Rehncrona S, Rosen I, Siesjo BK. Excessive cellular acidosis. An important mechanism of neuronal damage in the brain? Acta Physiol Scand 1980;110:435-7.
6. Stout RW. Hyperglicemia and stroke. Q J Med
1989;73:997-1004.
7. Feibel JH, Hardy PM, Campbell RG, et al. Prognostic value of the stress response following stroke. JAMA 1977;
238:1374-6.
8. Brass LM, Stys PK. Handbook of Neurological Lists. Churchill Livingstone Inc., New York, 1991.
9. Myers RE, Yamaguchi S. Nervous system effects of cardiac arrest in monkeys. Arch Neurol 1977; 34: 65-74,
10. Venables GS, Miller SA, Gibson G. The effects of hyperglycaemia on changes during reperfusion following focal cerebral ischaemia in the cat. J Neurol Neurosurg
Psychiatry 1985; 48: 663-9.
11. de Courten-Myers GM, Myers RE, Schoolfield L.
Hyperglycemia enlarges infarct size in cerebrovascular occlusion in cats. Stroke 1988; 19: 623-30.
12. Ginsberg MD, Prado R, Dietrich WD, et al. Hyperglycemia reduces the extent of cerebral infarction in rats. Stroke 1987;
18: 570-4.
13. Kraft SA, Larson CP Jr, Shuer LM, et al. Effect of
hyperglycemia on neuronal changes in a rabbit model of focal cerebral ischemia. Stroke 1990; 21: 447-50.
14. Samanta A, Blandford RL, Burden AC, et al. Glucose tolerance following strokes in the elderly. Age Ageing 1986;
15: 111-3.
15. Levy DE, Pulsinelli WA, Scherer PB, et al. Effect of
admission glucose level on recovery from acute stroke. Ann
Neurol 1985;18: 122.
16. Candelise L, Landi G, Nobile Orazio E, et al. Prognostic significance of hyperglycemia in acute stroke. Arch Neurol
1985; 42: 661-3.
17. Power MJ, Fullerton KJ, Stout RW. Blood glucose and prognosis of acute stroke. Age Ageing 1988; 17: 164-70.
18. Woo J, Lam CWK, Kay R, et al. The influence of
hyperglycemia and diabetes mellitus on immediate and 3-month morbidity and mortality after acute stroke. Arch Neurol 1990; 47: 1174-7.
19. Kushner M, Nencini P, Reivich M. Relation of hyperglycemia carly in ischemic brain infarction to cerebral anatomy, metabolism, and clinical outcome. Ann Neurol
1990; 28: 129-35.
20. Mohr JR, Ruubenstein LV, Tatemichi TK. Blood sugar and
acute stroke: The NINCDS Pilot Stroke Data Bank (abstract). Stroke 1985;16: 143.
21. Adams, HP, Olinger CP, Marler JR. Comparison of admission serum glucose concentration with neurologic outcome in acute cerebral infarction. A study in patients
given naloxone. Stroke 1988; 19: 455-8.
22. Abu-Zeid HAH, Choi NW, Hsu PH, et al. Prognostic factors in the survival of 1484 stroke cases observed for 30-49 months: II. Clinical variables and laboratory measurements. Arch Neurol 1978; 35. 213-8.
23. Mulley G, Wilcox RG, Mitchell JRA. Dexamethasone in acute stroke. Br Med J 1978; 2: 994-7.
24. O'Neill PA, Davies I, Fullerton KJ, et al. Stress hormone and blood glucose response following acute stroke in the elderly. Stroke1991; 22: 842-7.
25. Murros K, Fogelholm R, Kettunen S. Blood glucose, glycosylated haemoglobin, and outcome of ischemic brain
infarction. J. Neuro Sci 1992; 11:59-64.

Thank you for copying data from http://www.arastirmax.com