Acute ischemic stroke (AIS) is caused by a sudden interruption of cerebral blood flow, leading to ischemic injury of brain tissue. Currently, the prediction, prevention, and treatment of AIS still primarily rely on traditional glycolipid markers. However, their sensitivity, specificity, and correlation with AIS need further improvement. There is an urgent need to optimize the combination of these parameters to enhance their efficacy in diagnosis and treatment of AIS.

To investigate the predictive value of non-conventional lipid indices (TG/HDL-C ratio, remnant cholesterol, etc) and triglyceride-glucose index (TyG index) for AIS, and their correlation with the severity of neurological injury.

A total of 313 newly diagnosed AIS patients admitted to the Department of Encephalopathy Center in Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine between April 2023 and May 2024 were enrolled as the stroke group. At the same time, 709 healthy control people from the same hospital were collected as the control group. General demographic and laboratory data were collected from both groups. Multivariate Logistic regression analysis was used to identify independent factors for AIS. Spearman rank correlation analysis was performed to evaluate the correlation between indicators such as TyG, FPG, TG/HDL-C and National Institutes of Health Stroke Scale (NIHSS) scores in AIS patients, and receiver operating characteristic (ROC) curves were used to assess the predictive value of individual and combined indicators (including TyG, FPG, and TG/HDL-C) for AIS.

No significant differences were observed between the two groups in terms of age, gender, LDL-C, or total cholesterol (TC) (P>0.05). However, statistically significant differences were found in the proportions of patients with a history of hypertension, diabetes, atrial fibrillation, hyperlipidemia, as well as in the levels of TG, HDL-C, RC, TyG index, TG/HDL-C ratio, non-high-density lipoprotein cholesterol (non-HDL-C), FPG, platelet count, and the platelet to HDL-C ratio (PHR) (P<0.05). Multivariate Logistic regression analysis identified the TyG (OR=2.710, 95%CI=1.192-6.160, P=0.017), TG/HDL-C (OR=1.765, 95%CI=1.033-3.014, P=0.037), FPG (OR=1.288, 95%CI=1.101-1.506, P=0.002), and PHR (OR=1.003, 95%CI=1.000-1.006, P=0.043) as independent influencing factors for AIS occurrence. Spearman rank correlation analysis revealed positive correlations between the TyG index, TG/HDL-C ratio, TG levels, and the NIHSS score in AIS patients (r_s=0.148, 0.140, 0.119, respectively; P<0.05). The results of the ROC curve showed that the AUCs of the TyG index, TG/HDL-C, TG, FPG, and PHR for predicting AIS were 0.712, 0.674, 0.646, 0.723, and 0.588, respectively. The AUC of the combined prediction of TyG index + FPG + TG + TG/HDL-C for AIS was 0.762, with a sensitivity of 64.0% and a specificity of 78.7%, indicating stable performance at multiple thresholds and strong overall discrimination ability, its Youden index was 0.426. Other combinations showed: FPG+TG had an AUC of 0.750, sensitivity of 74.0%, specificity of 69.3%, and a Youden index of 0.432; FPG+TG/HDL-C had an AUC of 0.761, sensitivity of 76.7%, specificity of 68.3%, and a Youden index of 0.450; FPG+PHR had an AUC of 0.740, sensitivity of 72.1%, specificity of 71.7%, and a Youden index of 0.438; FPG+TyG index+PHR had an AUC of 0.757, sensitivity of 69.3%, specificity of 74.0%, and a Youden index of 0.432. The results indicate that while the combination of TyG index+FPG+TG+TG/HDL-C demonstrates excellent comprehensive performance at specific thresholds.

The TyG index, TG/HDL-C, FPG, and PHR are independently associated with the risk of AIS occurrence, and can reflect the severity of neurological damage in AIS. The combined use of TyG index, FPG, TG and TG/HDL-C for diagnosing AIS yields a relatively high AUC, while the combination of FPG and TG/HDL-C demonstrates a higher Youden index.

急性缺血性脑卒中（AIS）是由脑血流突然中断导致的脑组织缺血性损伤。目前对AIS的预测及防治主要依据传统糖脂类标志物，其灵敏度、特异度及与AIS的相关性还有待进一步提高，亟需对这些参数进行优化组合，以提高对AIS的防治及诊断效果。

探讨甘油三酯/高密度脂蛋白胆固醇比值（TG/HDL-C）、残余胆固醇（RC）等非常规脂质指标和甘油三酯-葡萄糖指数（TyG指数）对AIS的预测价值及其与神经损伤程度的相关性。

选取2023年4月—2024年5月南京中医药大学附属医院江苏省中医院脑病中心收治的313例初诊AIS患者为卒中组，另选取709例在本院体检中心行年度体检的体检健康者为对照组。收集两组的一般资料、实验室检查等资料。采用多因素Logistic回归分析探究AIS的独立影响因素，使用Spearman秩相关分析评估TyG指数、空腹血糖（FPG）、TG/HDL-C等指标与AIS患者美国国立卫生研究院卒中量表（NIHSS）评分之间的相关性，绘制受试者工作特征（ROC）曲线评估TyG、FPG、TG/HDL-C等指标单独及联合预测AIS的价值。

两组年龄、性别、低密度脂蛋白胆固醇（LDL-C）、总胆固醇（TC）比较，差异无统计学意义（P>0.05）。两组高血压病史、糖尿病病史、心房颤动病史、高脂血症病史所占比例及TG、HDL-C、RC、TyG指数、TG/HDL-C、非高密度脂蛋白胆固醇（non-HDL-C）、FPG、血小板计数（PLT）、血小板与高密度脂蛋白胆固醇比率（PHR）比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，TyG指数（OR=2.710，95%CI=1.192~6.160，P=0.017）、TG/HDL-C（OR=1.765，95%CI=1.033~3.014，P=0.037）、FPG（OR=1.288，95%CI=1.101~1.506，P=0.002）、PHR（OR=1.003，95%CI=1.000~1.006，P=0.043）是AIS发生的独立影响因素。Spearman秩相关分析显示，AIS患者TyG指数、TG/HDL-C、TG水平与NIHSS评分呈正相关（r_s值分别为0.148、0.140、0.119，P<0.05）。ROC曲线结果显示，TyG指数、TG/HDL-C、TG、FPG、PHR预测AIS的ROC曲线下面积（AUC）分别为0.712、0.674、0.646、0.723、0.588。TyG指数+FPG+TG+TG/HDL-C联合预测AIS的AUC为0.762，灵敏度为64.0%，特异度为78.7%，提示在多个阈值下性能稳定，整体区分能力强，约登指数为0.426；FPG+TG联合预测AIS的AUC为0.750，灵敏度为74.0%，特异度为69.3%，约登指数为0.432；FPG+TG/HDL-C联合预测AIS的AUC为0.761，灵敏度为76.7%，特异度为68.3%，约登指数为0.450；FPG+PHR联合预测AIS的AUC为0.740，灵敏度为72.1%，特异度为71.7%，约登指数为0.438；FPG+TyG指数+PHR联合预测AIS的AUC为0.757，灵敏度为69.3%，特异度为74.0%，约登指数为0.432；提示在特定阈值测试下，TyG指数+FPG+TG+TG/HDL-C的综合性能优异。

TyG指数、TG/HDL-C、FPG、PHR与AIS的发生风险独立相关，其在一定程度上能够反映AIS神经损伤的严重性。TyG指数+FPG+TG+TG/HDL-C联合诊断AIS的AUC较高，而FPG+TG/HDL-C联合诊断AIS的约登指数较高。