中国全科医学 ›› 2023, Vol. 26 ›› Issue (35): 4419-4424.DOI: 10.12114/j.issn.1007-9572.2023.0261

• 论著 • 上一篇    下一篇

三酰甘油葡萄糖指数与单发皮质下梗死患者发生早期神经功能恶化的相关性研究

罗伟刚1, 尹园园1, 刘万虎1, 徐玉珠1, 曹晓芸1, 步玮2, 张玲雁3, 任慧玲1,*()   

  1. 1.050051 河北省石家庄市,河北医科大学第三医院神经内科
    2.050051 河北省石家庄市,河北医科大学第三医院神经外科
    3.050000 河北省石家庄市裕华区裕兴街道办事处社区卫生服务中心
  • 收稿日期:2023-03-09 修回日期:2023-06-24 出版日期:2023-12-15 发布日期:2023-07-18
  • 通讯作者: 任慧玲

  • 作者贡献:罗伟刚负责研究设计,数据整理与分析,论文构思及撰写;罗伟刚、尹园园、刘万虎、徐玉珠负责资料及数据收集,文献查阅整理;曹晓芸、步玮进行论文修订;张玲雁、任慧玲负责文章的质量控制及审校,对文章整体负责、监督管理。
  • 基金资助:
    河北省重点科技研究计划项目(20170651); 2021年政府资助临床医学人才培养项目

Correlation of Triglyceride Glucose Index with Early Neurological Deterioration in Patients with Single Subcortical Infarction

LUO Weigang1, YIN Yuanyuan1, LIU Wanhu1, XU Yuzhu1, CAO Xiaoyun1, BU Wei2, ZHANG Lingyan3, REN Huiling1,*()   

  1. 1. Department of Neurology, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
    2. Department of Neurosurgery, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
    3. Yuhua District Yuxing Sub-district Office Community Health Service Center, Shijiazhuang 050000, China
  • Received:2023-03-09 Revised:2023-06-24 Published:2023-12-15 Online:2023-07-18
  • Contact: REN Huiling

摘要: 背景 早期神经功能恶化(END)是急性缺血性脑卒中后常见情况,END会导致患者功能障碍和死亡风险增加。三酰甘油葡萄糖指数(TyG指数)是急性缺血性脑卒中患者神经功能缺损严重程度的独立预测因素,也与早期复发性缺血性病变相关,而其与单发皮质下梗死(SSI)患者发生END的相关性研究鲜见报道,关系也尚不清楚。 目的 探讨TyG指数与SSI患者发生END的相关性。 方法 纳入2020—2021年河北医科大学第三医院神经内科诊断为SSI且在症状发作后72 h内入院的患者197例为研究对象,依据是否发生END,将患者分为END组(n=45)和非END组(n=152)。收集患者的临床资料,采用多因素Logistic回归分析探究TyG指数与SSI患者发生END的关系。采用受试者工作特征(ROC)曲线评估TyG指数对SSI患者发生END的预测价值。 结果 END组患者患有糖尿病比例、空腹血糖(FBG)、三酰甘油(TG)和TyG指数高于非END组(P<0.05)。多因素Logistic回归分析结果显示,TyG指数升高是SSI患者发生END的危险因素〔OR=1.726,95%CI(1.008,2.956),P=0.047〕。不同病变梗死部位上,TyG指数升高是梗死部位为基底节区的SSI患者发生END的危险因素〔OR=3.164,95%CI(1.290,7.760),P=0.012〕。TyG指数升高与梗死部位为半卵圆中心的SSI患者发生END无关(P>0.05)。TyG指数预测SSI患者发生END的ROC曲线下面积(AUC)为0.66〔95%CI(0.57,0.75),P=0.001〕,最佳截断值为8.61,灵敏度为0.689,特异度为0.638。根据TyG指数最佳截断值将患者分成TyG指数≥8.61者(n=86)和TyG指数<8.61者(n=111),与TyG指数<8.61者比较,TyG指数≥8.61者高脂血症比例、糖尿病比例、FBG、总胆固醇(TC)、TG、低密度脂蛋白(LDL)和END比例升高,年龄和高密度脂蛋白(HDL)降低(P<0.05)。 结论 TyG指数与SSI患者发生END有关,TyG指数升高是SSI患者发生END的独立危险因素,高TyG指数可预测基底节区的梗死患者发生END,但不可预测半卵圆中心的梗死患者发生END。

关键词: 缺血性卒中, 单发皮质下梗死, 三酰甘油葡萄糖指数, 胰岛素抵抗, 早期神经功能恶化, 相关性分析

Abstract:

Background

Early neurological deterioration (END) is common after acute ischemic stroke, which contributes to increased functional impairment and mortality in patients. Triglyceride glucose index (TyG index) is an independent predictor of the severity of neurological deficits in patients with acute ischemic stroke and is also associated with early recurrent ischemic lesions, however, its correlation with the incidence of END in single subcortical infarction (SSI) has been rarely reported and the correlation remains unclear.

Objective

To investigate the correlation between TyG index and the incidence of END in patients with SSI.

Methods

A total of 197 patients diagnosed with SSI and admitted within 72 h after symptom onset in the Department of Neurology, the Third Hospital of Hebei Medical University from 2020 to 2021 were included in the study and divided into the END group (n=45) and non-END group (n=152) based on whether END was developed. The clinical data of the patients were collected and multivariate Logistic regression analysis was used to investigate the correlation between TyG index and the incidence of END in patients with SSI. Receiver operating characteristic (ROC) curves were plotted to assess the predictive value of TyG index for END in patients with SSI.

Results

The proportion of patients with diabetes, FBG, TG and TyG index were higher in the END group than the non-END group (P<0.05). Multivariate Logistic regression showed that elevated TyG index was a risk factor for END in patients with SSI〔OR=1.726, 95%CI (1.008, 2.956), P=0.047〕. On different lesion infarct sites, elevated TyG index was a risk factor for END in SSI patients with basal ganglia as the infarction area〔OR=3.164, 95%CI (1.290, 7.760), P=0.012〕. Elevated TyG index was not associated with the occurrence of END in SSI patients with centrum semiovale as the infarction area (P>0.05). The ROC area under the curve (AUC) of TyG index for predicting END in patients with SSI was 0.66〔95%CI (0.57, 0.75), P=0.001〕, with an optimal cut-off value of 8.61, sensitivity of 0.689 and specificity of 0.638. Patients were divided into those with TyG index≥8.61 (n=86) and those with TyG index <8.61 (n=111) according to the optimal cut-off value of TyG index. Compared with those with TyG index<8.61, patients with TyG index≥8.61 had higher proportion of hyperlipidemia and diabetes, as well as higher levels of FBG, TC, TG, LDL and increased proportion of END, with lower age and HDL (P<0.05) .

Conclusion

TyG index is correlated with END in SSI patients, and increased TyG index is an independent risk factor for END in SSI patients, a high TyG index was significant in predicting the occurrence of END in patients with infarcts in the basal ganglia region, but not in patients with infarcts in the centrum semiovale.

Key words: Ischemic stroke, Single subcortical infarction, Triglyceride glucose index, Insulin resistance, Early neurological deterioration, Correlation analysis