Department of Medicine and Clinical Science (T. Kiyohara, R.M., J.H., K.N., Y.W., T. Kitazono, T.A.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Cerebrovascular Disease and Neurology, Hakujyuji Hospital, Fukuoka, Japan (T. Kiyohara).
Stroke. 2021 Aug;52(8):2621-2628. doi: 10.1161/STROKEAHA.120.031392. Epub 2021 May 14.
Little is known about how β-cell dysfunction affects clinical outcome after ischemic stroke. We examined whether β-cell function is associated with clinical outcome after acute ischemic stroke and if so, whether insulin resistance influences this association in a prospective study of patients with acute stroke.
A total of 3590 nondiabetic patients with acute ischemic stroke (mean age, 71 years) were followed up for 3 months. β-Cell function was assessed using the homeostasis model assessment for β-cell function (HOMA-β). Study outcomes were poor functional outcome (modified Rankin Scale score, 3–6) and stroke recurrence at 3 months after stroke onset and neurological deterioration (≥2-point increase in the National Institutes of Health Stroke Scale score) at discharge. Logistic regression analysis was used to evaluate the association between quintile levels of serum HOMA-β and clinical outcomes.
The age- and sex-adjusted odds ratios for poor functional outcome and neurological deterioration increased significantly with decreasing HOMA-β levels (P for trend, <0.001 and 0.001, respectively). These associations became more prominent after adjustment for HOMA-insulin resistance and were substantially unchanged even after further adjustment for other confounders, namely, body mass index, dyslipidemia, hypertension, estimated glomerular filtration rate, stroke subtype, National Institutes of Health Stroke Scale score on admission, and reperfusion therapy (odds ratio [95% CI] for the first versus fifth quintile of HOMA-β, 3.30 [2.15–5.08] for poor functional outcome and 10.69 [4.99–22.90] for neurological deterioration). Such associations were not observed for stroke recurrence. In stratified analysis for the combination of HOMA-β and HOMA-insulin resistance levels, lower HOMA-β and higher HOMA-insulin resistance levels were independently associated with increased risks of poor functional outcome and neurological deterioration.
Our findings suggest that β-cell dysfunction is significantly associated with poor short-term clinical outcome independently of insulin resistance in nondiabetic patients with acute ischemic stroke.
关于β细胞功能障碍如何影响缺血性卒中后的临床转归知之甚少。我们在一项急性卒中患者的前瞻性研究中，旨在探讨β细胞功能是否与急性缺血性卒中后的临床转归相关，以及胰岛素抵抗是否会影响这种相关性。
共纳入 3590 例非糖尿病急性缺血性卒中患者（平均年龄 71 岁），随访 3 个月。采用稳态模型评估β细胞功能（HOMA-β）评估β细胞功能。研究结局为 3 个月时的不良功能结局（改良 Rankin 量表评分 3-6 分）和卒中复发，以及卒中发病后出院时的神经功能恶化（美国国立卫生研究院卒中量表评分增加≥2 分）。采用 logistic 回归分析评估血清 HOMA-β五分位水平与临床结局之间的相关性。
在校正年龄和性别后，不良功能结局和神经功能恶化的比值比随着 HOMA-β 水平的降低而显著升高（趋势 P 值均<0.001）。在调整 HOMA-胰岛素抵抗后，这些相关性更加显著，即使进一步调整了其他混杂因素，如体重指数、血脂异常、高血压、估计肾小球滤过率、卒中亚型、入院时美国国立卫生研究院卒中量表评分和再灌注治疗后，这些相关性仍然基本不变（HOMA-β五分位中第 1 分位与第 5 分位相比的比值比[95%CI]，不良功能结局为 3.30[2.15-5.08]，神经功能恶化为 10.69[4.99-22.90]）。对于卒中复发，未观察到这种相关性。在 HOMA-β和 HOMA-胰岛素抵抗水平联合分层分析中，较低的 HOMA-β和较高的 HOMA-胰岛素抵抗水平与不良功能结局和神经功能恶化风险的增加独立相关。
我们的研究结果表明，在非糖尿病急性缺血性卒中患者中，β细胞功能障碍与胰岛素抵抗无关，与短期临床结局不良显著相关。
