Chen Shuaiyu, E Yan, Zhang Xiaohao, Wei Bin, Wang Siyu, Xu Zhaohan, Gong Pengyu, Xie Yi, Qin Chunhua, Zhang Yingdong
Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China.
Department of Neurology, Affiliated Hospital of Nantong University, Nantong, People's Republic of China.
Neuropsychiatr Dis Treat. 2023 Feb 5;19:321-328. doi: 10.2147/NDT.S394438. eCollection 2023.
Insulin resistance plays a pivotal role in the pathophysiology of ischemic stroke. This study aimed to determine the relationship between the novel metabolic score for insulin resistance (METS-IR) and symptomatic intracranial hemorrhage (sICH) after endovascular thrombectomy (EVT) in stroke patients.
We retrospectively included patients with large artery occlusion in the anterior circulation and treated by EVT from 2 stroke centers (Nanjing First Hospital from September 2019 to April 2022, and Jinling Hospital from September 2019 to July 2021). The METS-IR was used as an alternative marker of insulin resistance and calculated using laboratory data after admission. sICH was diagnosed according to the Heidelberg Bleeding Classification.
Of the 410 enrolled patients (mean age, 69.8 ± 11.7 years; 60.7% men), 50 (12.2%) were diagnosed as sICH. After adjusting for demographic characteristics, poor collateral status, and other potential confounders, higher METS-IR was revealed to be independently associated with sICH (odds ratio, 1.076; 95% confidence interval, 1.034-1.120; = 0.001). Similar significant results were obtained when defining METS-IR as a categorical variable. The restricted cubic spline uncovered a linear relationship between METS-IR and sICH ( < 0.001 for linearity). Furthermore, adding METS-IR to the conventional model significantly improved the risk prediction for sICH (net reclassification improvement = 15.8%, = 0.035; integrated discrimination index = 2.6%; = 0.017).
This study demonstrated a significant association between METS-IR score and sICH in ischemic stroke patients treated with EVT. It could help monitor and manage sICH in patients after EVT.
胰岛素抵抗在缺血性脑卒中的病理生理学中起关键作用。本研究旨在确定新型胰岛素抵抗代谢评分（METS-IR）与卒中患者血管内血栓切除术（EVT）后症状性颅内出血（sICH）之间的关系。
我们回顾性纳入了来自2个卒中中心（南京医科大学第一附属医院，2019年9月至2022年4月；金陵医院，2019年9月至2021年7月）的前循环大动脉闭塞且接受EVT治疗的患者。METS-IR被用作胰岛素抵抗的替代标志物，并根据入院后的实验室数据进行计算。sICH根据海德堡出血分类进行诊断。
在410例纳入患者中（平均年龄69.8±11.7岁；男性占60.7%），50例（12.2%）被诊断为sICH。在调整人口统计学特征、侧支循环状态不佳和其他潜在混杂因素后，较高的METS-IR被发现与sICH独立相关（比值比，1.076；95%置信区间，1.034-1.120；P = 0.001）。将METS-IR定义为分类变量时也获得了类似的显著结果。受限立方样条显示METS-IR与sICH之间存在线性关系（线性P<0.001）。此外，将METS-IR添加到传统模型中显著改善了sICH的风险预测（净重新分类改善 = 15.8%，P = 0.035；综合判别指数 = 2.6%，P = 0.017）。
本研究表明，在接受EVT治疗的缺血性卒中患者中，METS-IR评分与sICH之间存在显著关联。它有助于监测和管理EVT术后患者的sICH。
