降糖药物对远隔缺血适应治疗糖尿病 合并急性缺血性卒中患者的疗效影响: RICAMIS研究事后分析OA

Objective To investigate the effect of different antidiabetic drug regimens on the efficacy of remote ischemic conditioning(RIC)in the treatment of acute ischemic stroke. Methods Based on the remote ischemic conditioning for acute moderate ischemic stroke(RICAMIS)cohort,this study included patients with pre-existing or newly diagnosed diabetes and documented antidiabetic drug use.They were divided into three groups according to antidiabetic drug regimen:the insulin group,the oral hypoglycemic medication group,and the combined therapy group(insulin plus oral hypoglycemic medication).The primary outcome was excellent functional outcome at 90 days(mRS score 0-1).Secondary outcomes included favorable functional outcome at 90 days(mRS score 0-2),early neurological deterioration(defined as an increase of≥2 points in NIHSS score from baseline within 7 days of onset),change in NIHSS score at 12 days,and stroke-associated pneumonia within 12 days.The effects of RIC versus conventional medical therapy on these outcomes were compared within each group,and the interaction between different antidiabetic drug regimens and RIC efficacy was evaluated. Results A total of 378 patients were included in this study,including 131 in the insulin group(64 receiving RIC and 67 receiving conventional medical therapy),186 in the oral hypoglycemic medication group(88 receiving RIC and 98 receiving conventional medical therapy),and 61 in the combined therapy group(32 receiving RIC and 29 receiving conventional medical therapy).There were no statistically significant differences in the proportions of excellent or favorable functional outcomes between RIC and conventional medical therapy within each of the three groups.In the insulin group,the incidence of early neurological deterioration was significantly higher with RIC than with conventional medical therapy(14.1%vs.3.0%,OR 5.32,95%CI 1.10-25.66,P=0.04).Similarly,in the oral hypoglycemic medication group,RIC was associated with a significantly increased risk of early neurological deterioration(22.7%vs.11.2%,adjusted OR 2.33,95%CI 1.03-5.29,P=0.04).In the combined therapy group,no significant difference was observed between RIC and conventional medical therapy(adjusted P=0.48).No significant differences were found in changes in NIHSS score at 12 days or the incidence of stroke-associated pneumonia within 12 days between RIC and conventional medical therapy across the three groups.Interaction analysis showed no interaction between antidiabetic drug regimens and treatment assignment for any of the aforementioned outcomes(all P values for interaction>0.05). Conclusions In patients with diabetes complicated by acute ischemic stroke,RIC did not improve 90-day functional outcomes compared with conventional medical therapy across different antidiabetic drug regimens.RIC increased the risk of early neurological deterioration in patients treated with either insulin or oral hypoglycemic agents.