Department of Endocrinology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China.
Department of Neurology, Hongqi Hospital of Mudanjiang Medical University, Mudanjiang 157011, China.
Biosci Rep. 2018 May 8;38(3). doi: 10.1042/BSR20180330. Print 2018 Jun 29.
Whether insulin resistance (IR) predicts worse functional outcome in ischemic stroke is still a matter of debate. The aim of the present study is to determine the association between IR and risk of poor outcome in 173 Chinese nondiabetic patients with acute ischemic stroke. This is a prospective, population-based cohort study. Insulin sensitivity, expressed by the homeostasis model assessment (HOMA) of insulin sensitivity (HOMA index = (fasting insulin × fasting glucose)/22.5). IR was defined by HOMA-IR index in the top quartile (Q4). Functional impairment was evaluated at discharge using the modified Rankin scale (mRS). The median (interquartile range) HOMA-IR was 2.14 (1.17-2.83), and Q4 was at least 2.83. There was a significantly positive correlation between HOMA-IR and National Institutes of Health Stroke Scale ( = 0.408; <0.001). In multivariate analyses, patients in IR group were associated with a higher risk of poor functional outcome (odds ratio (OR) = 3.23; 95% confidence interval (CI) = 1.75-5.08; =0.001). In multivariate models comparing the third and fourth quartiles against the first quartile of the HOMA-IR, levels of HOMA-IR were associated with poor outcome, and the adjusted risk of poor outcome increased by 207% (OR = 3.05 (95% CI 1.70-4.89), =0.006) and 429% (5.29 (3.05-9.80), <0.001). In a receiver operating characteristic curve (ROC) analysis of poor outcome, the area under the curve (AUC) increased from 0.80 to 0.84 (95% CI: 0.79-0.88) by adding HOMA-IR to clinical examination variables (=0.02). High HOMA-IR index is associated with a poor functional outcome in nondiabetic patients with acute ischemic stroke.
胰岛素抵抗（IR）是否预示着缺血性卒中患者的功能预后更差仍存在争议。本研究旨在确定 173 例中国非糖尿病急性缺血性卒中患者的 IR 与不良预后风险之间的关系。这是一项前瞻性的基于人群的队列研究。胰岛素敏感性由稳态模型评估（HOMA）的胰岛素敏感性（HOMA 指数=（空腹胰岛素×空腹血糖）/22.5）表示。IR 通过 HOMA-IR 指数的四分位 Q4 定义。使用改良 Rankin 量表（mRS）在出院时评估功能障碍。HOMA-IR 的中位数（四分位距）为 2.14（1.17-2.83），Q4 至少为 2.83。HOMA-IR 与国立卫生研究院卒中量表（NIHSS）之间存在显著的正相关（r=0.408；<0.001）。在多变量分析中，IR 组患者功能预后不良的风险更高（优势比（OR）=3.23；95%置信区间（CI）=1.75-5.08；<0.001）。在比较 HOMA-IR 第三和第四四分位与第一四分位的多变量模型中，HOMA-IR 水平与不良预后相关，不良预后的调整风险增加 207%（OR=3.05（95%CI 1.70-4.89），=0.006）和 429%（OR=5.29（95%CI 3.05-9.80），<0.001）。在不良预后的受试者工作特征曲线（ROC）分析中，通过将 HOMA-IR 添加到临床检查变量中，曲线下面积（AUC）从 0.80 增加到 0.84（95%CI：0.79-0.88）（=0.02）。高 HOMA-IR 指数与非糖尿病急性缺血性卒中患者的不良功能预后相关。
