Department of Neurology, Beni-Suef University, Beni-Suef, Egypt.
Department of Neurology, Cairo University, Cairo, Egypt.
Acta Neurol Belg. 2023 Jun;123(3):885-892. doi: 10.1007/s13760-022-02060-6. Epub 2022 Aug 20.
The potential impact of insulin resistance on stroke prognosis after IV thrombolysis is poorly understood. This study aimed to assess the effect of insulin resistance and metabolic syndrome on the outcome of IV thrombolysis in non-diabetic patients with acute ischaemic stroke.
This prospective observational study was conducted on 70 non-diabetic acute ischaemic stroke patients who received rt-PA within 3 h of stroke onset. Patients were subjected to baseline and follow-up NIHSS measurements at 24 h and 3 months post-treatment. Stroke outcome was assessed after 3 months using the Modified Rankin Scale (mRS). The homeostasis model assessment-insulin resistance (HOMA-IR) was calculated for the included patients at stroke onset.
The mean age of included patients was 57.04 ± 14.39 years. Patients with unfavourable outcome had a significantly higher frequency of insulin resistance and metabolic syndrome, higher values of baseline NIHSS, insulin, HOMA-IR, uric acid and lower levels of HDL than those with favourable outcome (P value = 0.035, 0.007, ≤ 0.001, 0.001, ≤ 0.001, 0.002, 0.033, respectively). Each point increase in NIHSS before rt-PA increased the odds of an unfavourable outcome by 2.06 times (95% CI 1.22 - 3.478). Also, insulin resistance increased the odds of the unfavourable outcome by 11.046 times (95% CI 1.394-87.518). There was a statistically significant improvement in NIHSS 3 months after receiving rt-PA in all patients, significantly higher in patients who did not have insulin resistance or metabolic syndrome.
Insulin resistance and metabolic syndrome were associated with worse functional outcomes in non-diabetic stroke patients after receiving rt-PA.
胰岛素抵抗对接受 IV 溶栓治疗后的卒中预后的潜在影响尚未完全明确。本研究旨在评估胰岛素抵抗和代谢综合征对非糖尿病急性缺血性卒中患者接受 IV 溶栓治疗结局的影响。
这是一项前瞻性观察研究，共纳入 70 例发病 3 小时内接受 rt-PA 治疗的非糖尿病急性缺血性卒中患者。患者在治疗后 24 小时和 3 个月时分别接受基线和随访 NIHSS 测量。3 个月后采用改良 Rankin 量表（mRS）评估卒中结局。在卒中发病时对纳入患者进行稳态模型评估-胰岛素抵抗（HOMA-IR）计算。
纳入患者的平均年龄为 57.04±14.39 岁。预后不良患者的胰岛素抵抗和代谢综合征发生率更高，基线 NIHSS、胰岛素、HOMA-IR、尿酸水平更高，HDL 水平更低，与预后良好患者相比差异有统计学意义（P 值分别为 0.035、0.007、≤0.001、0.001、≤0.001、0.002、0.033）。rt-PA 治疗前 NIHSS 每增加 1 分，不良结局的发生风险增加 2.06 倍（95%CI 1.22-3.478）。胰岛素抵抗使不良结局的发生风险增加 11.046 倍（95%CI 1.394-87.518）。所有患者在接受 rt-PA 治疗 3 个月后 NIHSS 均有统计学显著改善，无胰岛素抵抗或代谢综合征的患者改善更明显。
在接受 rt-PA 治疗后，非糖尿病卒中患者的胰岛素抵抗和代谢综合征与更差的功能结局相关。
