Wang Qiao, Zhao Yuanyuan, Wang Xiang, Ji Xiaokang, Sang Shaowei, Shao Sai, Ma Xiaotong, Wang Guangbin, Lv Ming, Xue Fuzhong, Du Yifeng, Sun Qinjian
Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
BMJ Open Diabetes Res Care. 2020 Dec;8(2). doi: 10.1136/bmjdrc-2020-001788.
Recent studies have shown that insulin resistance (IR) is correlated to atherosclerosis development. However, few studies have investigated the association between IR and asymptomatic intracranial arterial stenosis (aICAS).
This cross-sectional study enrolled 2007 rural residents in China who were aged ≥40 years without a clinical history of stroke and transient ischaemic attack. We used transcranial Doppler ultrasonography in combination with magnetic resonance angiography to diagnose aICAS (stenosis ≥50%). IR was defined as a homeostasis model assessment of insulin resistance ≥3.0 based on the 75th percentile for all the participants. Multivariate logistic regression models were employed to assess the relationship of diabetic parameters with aICAS in all participants, as well as with aICAS in non-diabetic participants, and further stratified by sex.
After adjusting for age, gender, smoking habit, drinking habit, low-density lipoprotein cholesterol, raised blood pressure, triglycerides, high-density lipoprotein cholesterol and waist circumference, diabetes mellitus (DM) (OR=2.09, 95% CI 1.31 to 3.32), fasting plasma glucose (FPG) (OR=1.34, 95% CI 1.14 to 1.57), and IR (OR=1.75, 95% CI 1.11 to 2.75) were associated with aICAS in the total study population; however, these relationships remained significant only in men after the analyses were stratified by sex (DM: OR=3.40, 95% CI 1.62 to 7.13; FPG: OR=1.64, 95% CI 1.26 to 2.13; IR: OR=3.04, 95% CI 1.44 to 6.42). When further excluding the diabetic participants from the total study population, positive associations between IR and aICAS were similarly observed only in men (OR=4.65, 95% CI 1.69 to 12.82).
IR might predict the prevalence of aICAS independently of major cardiovascular risk factors and metabolic syndrome components among men living in rural China.
近期研究表明，胰岛素抵抗（IR）与动脉粥样硬化的发展相关。然而，很少有研究探讨IR与无症状颅内动脉狭窄（aICAS）之间的关联。
这项横断面研究纳入了2007名年龄≥40岁、无中风和短暂性脑缺血发作临床病史的中国农村居民。我们使用经颅多普勒超声联合磁共振血管造影来诊断aICAS（狭窄≥50%）。IR被定义为基于所有参与者第75百分位数的胰岛素抵抗稳态模型评估≥3.0。采用多变量逻辑回归模型评估糖尿病参数与所有参与者中aICAS的关系，以及与非糖尿病参与者中aICAS的关系，并按性别进一步分层。
在调整年龄、性别、吸烟习惯、饮酒习惯、低密度脂蛋白胆固醇、高血压、甘油三酯、高密度脂蛋白胆固醇和腰围后，糖尿病（DM）（比值比[OR]=2.09，95%置信区间[CI]1.31至3.32）、空腹血糖（FPG）（OR=1.34，95%CI 1.14至1.57）和IR（OR=1.75，95%CI 1.11至2.75）与整个研究人群中的aICAS相关；然而，按性别分层分析后，这些关系仅在男性中仍然显著（DM：OR=3.40，95%CI 1.62至7.13；FPG：OR=1.64，95%CI 1.26至2.13；IR：OR=3.04，95%CI 1.44至6.42）。当从整个研究人群中进一步排除糖尿病参与者时，仅在男性中同样观察到IR与aICAS之间的正相关（OR=4.65，95%CI 1.69至12.82）。
在中国农村男性中，IR可能独立于主要心血管危险因素和代谢综合征成分预测aICAS的患病率。
