Department of Neurology, Ewha Womans University Mokdong Hospital and Ewha University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, South Korea.
Department of Neurology, Korea University Guro Hospital and Korea University College of Medicine, 148 Gurodong-Ro, Guro-gu, Seoul, 08308, South Korea.
Sci Rep. 2021 Jan 13;11(1):1229. doi: 10.1038/s41598-020-80315-z.
Insulin resistance is associated with the occurrence of stroke and atherosclerotic disease. However, the relationship between insulin resistance and the prognosis of acute ischemic stroke in non-diabetic patients is unclear. We hypothesized that insulin resistance might affect short-term functional recovery after acute ischemic stroke in non-diabetic patients. Between May 2014 and December 2016, 1377 consecutive patients with acute ischemic stroke were enrolled from a prospectively maintained stroke registry. After excluding patients with transient ischemic attacks (TIA), pre-stroke disabilities, diabetes mellitus, and patients with incomplete evaluations, 517 patients were included in the study. The homeostasis model assessment of insulin resistance (HOMA-IR) score was used to evaluate the degree of insulin resistance. The patients with the highest quartile of log HOMA-IR index scores were younger and had higher fasting blood glucose, total cholesterol, triglycerides, low-density lipoprotein, and HbA1c levels. Multivariable logistic regression analysis revealed that log HOMA-IR scores were independently associated with poor prognosis after adjusting for age and sex and p < 0.1 in univariable analysis. Insulin resistance was associated with the poor functional outcome of non-diabetic stroke patients. This evidence supports treating insulin resistance in acute ischemic stroke patients with blood glucose levels within the normal range.
胰岛素抵抗与中风和动脉粥样硬化性疾病的发生有关。然而，胰岛素抵抗与非糖尿病患者急性缺血性卒中预后之间的关系尚不清楚。我们假设胰岛素抵抗可能会影响非糖尿病患者急性缺血性卒中后的短期功能恢复。在 2014 年 5 月至 2016 年 12 月期间，从前瞻性维持的卒中登记处纳入了 1377 例连续急性缺血性卒中患者。排除短暂性脑缺血发作（TIA）、卒中前残疾、糖尿病和评估不完整的患者后，共有 517 例患者纳入研究。采用稳态模型评估胰岛素抵抗（HOMA-IR）评分评估胰岛素抵抗程度。HOMA-IR 指数评分最高四分位数的患者更年轻，且空腹血糖、总胆固醇、甘油三酯、低密度脂蛋白和 HbA1c 水平更高。多变量逻辑回归分析显示，在调整年龄和性别后，log HOMA-IR 评分与预后不良独立相关，且在单变量分析中 p<0.1。胰岛素抵抗与非糖尿病卒中患者的不良功能结局相关。这一证据支持在血糖水平正常范围内治疗急性缺血性卒中患者的胰岛素抵抗。
