Liao Canlin, Xu Haixiong, Jin Tao, Xu Ke, Xu Zhennan, Zhu Lingzhen, Liu Mingfa
Department of Neurosurgery, Shantou Central Hospital, Shantou, Guangdong, China.
Front Neurol. 2023 Jan 4;13:1033385. doi: 10.3389/fneur.2022.1033385. eCollection 2022.
Insulin resistance (IR) is involved in the pathogenesis of atherosclerosis. As a new indicator, the triglyceride-glucose (TyG) index has greater operability for the evaluation of insulin resistance. Previous studies have shown inconsistent results in evaluating the association between the TyG index and stroke incidence in people without stroke at baseline. Therefore, this study aimed to systematically assess this association through a meta-analysis.
Cohort studies with the multivariate-adjusted hazard ratio (HR) association between the TyG index and stroke were obtained by searching the PubMed, Cochrane Library, and EMBASE databases before 16 December 2021. We pooled the adjusted HR along with 95% CI using a random-effects model. The primary outcome was stroke including ischemic and hemorrhagic stroke. We conducted subgroup analyses stratified by study design, ethnicity, characteristics of participants, weight of studies, and length of follow-up duration. Review Manager 5.3 and Stata 17 were used to perform the meta-analysis.
Eight cohort studies with 5,804,215 participants were included. The results showed that participants with the highest TyG index category at baseline compared to those with the lowest TyG index category were independently associated with a higher risk of stroke (HR: 1.26, 95% CI: 1.24-1.29, I = 0%, < 0.001). This finding was consistent with the results of the meta-analysis with the TyG index analyzed as a continuous variable (HR per each-unit increment of the TyG index: 1.13, 95% CI 1.09-1.18, I = 0%, < 0.001). Subgroup analysis had no significant effects (for subgroup analysis, all > 0.05). No significant heterogeneity was observed among the included cohort studies.
A higher TyG index may be independently associated with a higher risk of stroke in individuals without stroke at baseline. The aforementioned findings need to be verified by a large-scale prospective cohort study to further clarify the underlying pathophysiological mechanism between the TyG index and stroke.
胰岛素抵抗（IR）参与动脉粥样硬化的发病机制。作为一项新指标，甘油三酯-葡萄糖（TyG）指数在评估胰岛素抵抗方面具有更高的可操作性。既往研究在评估基线时无卒中人群中TyG指数与卒中发生率之间的关联时结果不一致。因此，本研究旨在通过荟萃分析系统评估这种关联。
通过检索2021年12月16日前的PubMed、Cochrane图书馆和EMBASE数据库，获取关于TyG指数与卒中之间多变量调整风险比（HR）关联的队列研究。我们使用随机效应模型汇总调整后的HR及95%置信区间（CI）。主要结局是卒中，包括缺血性卒中和出血性卒中。我们按研究设计、种族、参与者特征、研究权重和随访持续时间进行亚组分析。使用Review Manager 5.3和Stata 17进行荟萃分析。
纳入8项队列研究，共5,804,215名参与者。结果显示，与基线时TyG指数类别最低者相比，基线时TyG指数类别最高的参与者独立于其他因素与更高的卒中风险相关（HR：1.26，95%CI：1.24 - 1.29，I² = 0%，P < 0.001）。这一发现与将TyG指数作为连续变量进行荟萃分析的结果一致（TyG指数每增加一个单位的HR：1.13，95%CI 1.09 - 1.18，I² = 0%，P < 0.001）。亚组分析无显著影响（对于亚组分析，所有P > 0.05）。纳入的队列研究之间未观察到显著的异质性。
较高的TyG指数可能独立于其他因素与基线时无卒中个体的更高卒中风险相关。上述发现需要通过大规模前瞻性队列研究进行验证，以进一步阐明TyG指数与卒中之间潜在的病理生理机制。
