Effect Of The Stress Hyperglycemia Ratio In First-ever Penetrating Artery Infarction, A Comparison Study Between Different Subtypes Ischemic Stroke Patients

Background and Objective: The pathogenesis and risk factors of branch atheromatous disease(BAD),which differs from lipohyalinotic degeneration(LD),remains controversial.By observing the change of blood glucose in patients with different infarct sites and different infarction types,we aimed to determine the association between stress hyperglycemia ratio and long-term prognosis in patients with first-ever penetrating artery infarction and to explore the possible pathogenesis.Methods : Consecutive January 2015 to June 2017 at the Second Affiliated Hospital of Nanchang University,and the subjects were 3508 patients in the Department of Neurology.We retrospectively examined acute stroke patients with PAI admitted within 3 days after stroke.According to the inclusion and exclusion criteria of this study,181 cases were eventually included.Stress hyperglycemia ratio(SHR)was measured by Fasting blood glucose/hemoglobin A1C(HbA1c),The primary outcome was valuated at 180 day based on modified Rankin scale(mRS)scores.We retrospectively assessed the risk factors of PAI and prospectively explored the relationship between SHR and the long-term outcomes.Results: SHR was associated with long-term poor prognosis in patients(Spearman’s correlation coefficient=0.152,Sig=0.041),and this correlation was not significant in fasting blood glucose(Spearman’s correlation coefficient=0.136,Sig=0.068);the SHR of patients in the poor outcome group was significantly higher than that of the good outcome group(1.03±0.23 VS.0.93±0.15,P=0.004).Fasting blood glucose(P=0.033)and HbA1c(P=0.033)were significantly higher in the BAD group than the LD group;Fasting blood glucose(P=0.008)and HbA1c(P=0.006)levels were lower in the PPA group than in the LSA group.The poor prognosis was associated with elderly(64.38±10.631 VS.58.99±10.967 years,P=0.013)and high serum creatinine(78.88±24.49 VS.70.49±15.96umol/L,P=0.016),and the difference was statistically significant.Compared with BAD group,patients with LD had significantly higher serum creatinine(77.98±16.75 VS.67.11±17.53,P<0.001)and hemoglobin(139.69±13.71 VS.134.95±16.58,P=0.037),while in other indicatorssuch as HDL,LDL,cholesterol,triglycerides,there was no statistical difference(P>0.05)between the two groups.Conclusions:1 Stress hyperglycemia ratio,which was measured by Fasting blood glucose/hemoglobin A1C(HbA1c),was associated with long-term adverse outcomes stroke in patients with first-ever penetrating artery infarction.2 Glucose metabolism has a greater impact on BAD patients.3 Serum creatinine may be a predictor of poor prognosis.4 LSA is the most common area of perforator artery infarction,and BAD is more common in paramedian pontine arteries.