Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.
Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China; Department of Neurology, Shanghai Ninth People's Hospital(North Part), Shanghai Jiaotong University, Shanghai, China.
J Stroke Cerebrovasc Dis. 2021 Mar;30(3):105526. doi: 10.1016/j.jstrokecerebrovasdis.2020.105526. Epub 2020 Dec 16.
to investigate the relationship between insulin resistance (IR) and clinical outcomes in non-diabetic ischemic stroke patients treated with intravenous thrombolysis.
We recruited non-diabetic ischemic stroke patients treated with intravenous thrombolysis prospectively. IR was defined as homeostasis model assessment-estimated insulin resistance index ≥2.80. Initial stroke severity was assessed using the National Institutes of Health Stroke Scale scores, and infarct volume was measured using DWI. Clinical outcomes were evaluated by neurological improvement and hemorrhagic transformation at 24 hours, and favorable functional prognosis at 90 days.
232 patients were enrolled into this study. IR group was 67 patients, non-IR group was 165 patients. Compared with the non-IR group, the probability of neurological improvement at 24 h ours and favorable functional outcome at 90 days in IR group were all significantly lower (41.79% vs 63.03%, p<0.01; 73.13% vs 89.09%, p<0.01 respectively), whereas the ratio of hemorrhagic transformation was much higher (16.42% vs 4.85%, p<0.01). In multivariable logistic regression, IR was negatively associated with neurological improvement and favorable functional prognosis (OR=0.39, 95%CI, 0.20-0.76, p<0.01; OR= 0.26, 95%CI, 0.07-0.91, p=0.04, respectively), but was positively correlated with hemorrhagic transformation (OR=4.07, 95%CI, 1.13-14.59, p=0.03) after adjusting traditional risk factors. We analyzed 108 infarct volume data further, the median of volume in IR group was 2.27 cm, higher than that in non-IR group (1.96 cm), but no statistical difference (p=0.65).
In non-diabetic ischemic stroke patients treated with intravenous thrombolysis, IR was related with worse clinical outcomes, but not with infarct volume.
探讨接受静脉溶栓治疗的非糖尿病缺血性脑卒中患者胰岛素抵抗（IR）与临床结局的关系。
前瞻性纳入接受静脉溶栓治疗的非糖尿病缺血性脑卒中患者。IR 定义为稳态模型评估-估计的胰岛素抵抗指数≥2.80。采用美国国立卫生研究院卒中量表评分评估初始卒中严重程度，采用 DWI 测量梗死体积。通过 24 小时时的神经改善和出血转化以及 90 天时的良好功能预后来评估临床结局。
本研究共纳入 232 例患者。IR 组 67 例，非 IR 组 165 例。与非 IR 组相比，IR 组 24 小时时神经改善的概率和 90 天时的良好功能预后均显著降低（41.79%比 63.03%，p<0.01；73.13%比 89.09%，p<0.01），而出血转化率则显著升高（16.42%比 4.85%，p<0.01）。多变量逻辑回归分析显示，IR 与神经改善和良好的功能预后呈负相关（OR=0.39，95%CI，0.20-0.76，p<0.01；OR=0.26，95%CI，0.07-0.91，p=0.04），但与出血转化呈正相关（OR=4.07，95%CI，1.13-14.59，p=0.03），校正传统危险因素后结果仍有统计学意义。我们进一步分析了 108 例梗死体积数据，IR 组的中位数为 2.27cm，高于非 IR 组（1.96cm），但差异无统计学意义（p=0.65）。
在接受静脉溶栓治疗的非糖尿病缺血性脑卒中患者中，IR 与临床结局较差相关，而与梗死体积无关。
