Department of Neurology, First Hospital of Shanxi Medical University, No. 85, Jiefangnan Street, Yingze District, Taiyuan, Shanxi, China.
Clinical College, Shanxi Medical University, No. 58, Xinjiannan Street, Yingze District, Taiyuan, Shanxi, China.
Cardiovasc Diabetol. 2023 Apr 19;22(1):90. doi: 10.1186/s12933-023-01823-6.
The triglyceride-glucose (TyG) index, a simple measure of insulin resistance, is associated with intracranial atherosclerosis (ICAS) and stroke. In hypertensive populations, this association may be pronounced. The aim was to investigate the relationship between TyG and symptomatic intracranial atherosclerosis (sICAS) and recurrence risk in ischemic stroke patients with hypertension.
This prospective, multicenter cohort study included patients with acute minor ischemic stroke with a preadmission diagnosis of hypertension from September 2019 to November 2021 with a 3-month follow-up. The presence of sICAS was determined by a combination of clinical manifestations, the location of the infarction, and the corresponding artery with moderate-to-severe stenosis. ICAS burden was determined by the degree and number of ICAS occurrences. Fasting blood glucose (FBG) and triglyceride (TG) were measured to calculate TyG. The main outcome was ischemic stroke recurrence during the 90-day follow-up. Multivariate regression models were used to explore the association of TyG, sICAS, and ICAS burden with stroke recurrence.
There were 1281 patients with a mean age of 61.6 ± 11.6 years; 70.1% were male, and 26.4% were diagnosed with sICAS. There were 117 patients who experienced stroke recurrence during follow-up. Patients were categorized according to quartiles of TyG. After adjusting for confounders, the risk of sICAS was greater (OR 1.59, 95% CI 1.04-2.43, p = 0.033) and the risk of stroke recurrence was significantly higher (HR 2.02, 95% CI 1.07-3.84, p = 0.025) in the fourth TyG quartile than in the first quartile. The restricted cubic spline (RCS) plot revealed a linear relationship between TyG and sICAS, and the threshold value for TyG was 8.4. Patients were then dichotomized into low and high TyG groups by the threshold. Patients with high TyG combined with sICAS had a higher risk of recurrence (HR 2.54, 95% CI 1.39-4.65) than patients with low TyG without sICAS. An interaction effect on stroke recurrence between TyG and sICAS was found (p = 0.043).
TyG is a significant risk factor for sICAS in hypertensive patients, and there is a synergistic effect of sICAS and higher TyG on ischemic stroke recurrence.
The study was registered on 16 August 2019 at https://www.chictr.org.cn/showprojen.aspx?proj=41160 (No. ChiCTR1900025214).
甘油三酯-葡萄糖（TyG）指数是一种简单的胰岛素抵抗衡量指标，与颅内动脉粥样硬化（ICAS）和中风有关。在高血压人群中，这种关联可能更为明显。本研究旨在探讨 TyG 与症状性颅内动脉粥样硬化（sICAS）以及高血压缺血性中风患者复发风险之间的关系。
这是一项前瞻性、多中心队列研究，纳入了 2019 年 9 月至 2021 年 11 月期间因急性小灶性缺血性中风且入院前诊断为高血压的患者，随访时间为 3 个月。sICAS 的存在通过临床表现、梗死部位和相应的中重度狭窄动脉来确定。ICAS 负担通过 ICAS 的程度和数量来确定。测量空腹血糖（FBG）和甘油三酯（TG）来计算 TyG。主要结局为 90 天随访期间的缺血性中风复发。采用多变量回归模型探讨 TyG、sICAS 和 ICAS 负担与中风复发的关系。
共纳入 1281 例患者，平均年龄为 61.6±11.6 岁；70.1%为男性，26.4%诊断为 sICAS。随访期间有 117 例患者发生中风复发。根据 TyG 的四分位数对患者进行分类。调整混杂因素后，第 4 四分位数 TyG 患者的 sICAS 风险更高（OR 1.59，95%CI 1.04-2.43，p=0.033），中风复发风险显著升高（HR 2.02，95%CI 1.07-3.84，p=0.025），高于第 1 四分位数。限制性立方样条（RCS）图显示 TyG 与 sICAS 之间呈线性关系，TyG 的截断值为 8.4。然后根据该截断值将患者分为低 TyG 组和高 TyG 组。TyG 较高且合并 sICAS 的患者复发风险更高（HR 2.54，95%CI 1.39-4.65），高于 TyG 较低且无 sICAS 的患者。TyG 和 sICAS 之间的中风复发存在交互效应（p=0.043）。
TyG 是高血压患者 sICAS 的重要危险因素，sICAS 和较高 TyG 对缺血性中风复发有协同作用。
该研究于 2019 年 8 月 16 日在 https://www.chictr.org.cn/showprojen.aspx?proj=41160（注册号：ChiCTR1900025214）注册。
