Liu Ruishan, Li Lijuan, Wang Lu, Zhang Shihong
Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.
Front Neurol. 2023 Aug 3;14:1198487. doi: 10.3389/fneur.2023.1198487. eCollection 2023.
The triglyceride-glucose index (TGI), a reliable surrogate indicator of insulin resistance (IR), has been proven to be a predictor of the incidence of ischemic stroke. The role of TGI in predicting the outcomes of stroke patients remains controversial. Susceptibility to IR-related diseases varies among patients of different ages. The study aims to evaluate the predictive value of TGI levels on clinical outcomes of patients with ischemic stroke of different ages.
This was a retrospective cohort study including patients with ischemic stroke in the Department of Neurology at West China Hospital. TGI was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The patients were subdivided into 3 tertiles according to TGI levels. Multivariate logistic regression analyses were conducted to estimate the association between TGI levels and post-stroke outcomes among the whole patients, younger patients (<65), and older patients (>=65). The outcomes included death and unfavorable functional outcome (modified Rankin scale score 3-6) at 3 and 12 months after stroke.
A total of 3,704 patients (men, 65.08%, mean age, 61.44 ± 14.15; women 34.92%, mean age, 65.70 ± 13.69) were enrolled in this study. TGI levels were not associated with 3 month or 12 month death in the whole patients. Patients with higher TGI levels (T2 and T3) had a higher risk of 3 month death than those had lower TGI levels (T1) in the younger group (T2 vs. T1: OR 2.64, 95% CI 1.03-6.79, = 0.043; T3 vs. T1: OR 2.69, 95% CI 1.00-7.10, = 0.049) but not in the older group. Additionally, Kaplan-Meier estimate analysis illustrated that the 12 month death risk was significantly higher in the group with the highest TGI among younger patients ( for log-rank test = 0.028) but not among older patients. There was an interactive effect between TGI and age on 3 month death ( for interaction = 0.013) and 12 month death ( for interaction = 0.027). However, TGI was not associated with unfavorable functional outcome at 3 month or 12 month after stroke.
Elevated TGI independently predicts death at 3 months and 12 months in patients under 65 with ischemic stroke. Regulating TGI is expected to be an approach to enhance prognosis in young individuals affected by ischemic stroke.
甘油三酯-葡萄糖指数（TGI）作为胰岛素抵抗（IR）的可靠替代指标，已被证明是缺血性脑卒中发病的预测因子。TGI在预测脑卒中患者预后方面的作用仍存在争议。不同年龄患者对IR相关疾病的易感性各不相同。本研究旨在评估TGI水平对不同年龄缺血性脑卒中患者临床预后的预测价值。
这是一项回顾性队列研究，纳入了华西医院神经内科的缺血性脑卒中患者。TGI的计算方法为ln[空腹甘油三酯（mg/dL）×空腹血糖（mg/dL）/2]。根据TGI水平将患者分为3个三分位数。进行多因素逻辑回归分析，以估计全组患者、年轻患者（<65岁）和老年患者（≥65岁）中TGI水平与卒中后结局之间的关联。结局包括卒中后3个月和12个月时的死亡和不良功能结局（改良Rankin量表评分3-6分）。
本研究共纳入3704例患者（男性占65.08%，平均年龄61.44±14.15岁；女性占34.92%，平均年龄65.70±13.69岁）。在全组患者中，TGI水平与3个月或12个月时的死亡无关。在年轻组中，TGI水平较高（T2和T3）的患者3个月死亡风险高于TGI水平较低（T1）的患者（T2与T1比较：比值比2.64，95%可信区间1.03-6.79，P=0.043；T3与T1比较：比值比2.69，95%可信区间1.00-7.10，P=0.049），而在老年组中并非如此。此外，Kaplan-Meier估计分析表明，年轻患者中TGI最高组的12个月死亡风险显著更高（对数秩检验P=0.028），而老年患者中并非如此。TGI与年龄在3个月死亡（交互作用P=0.013）和12个月死亡（交互作用P=0.027）方面存在交互作用。然而，TGI与卒中后3个月或12个月时的不良功能结局无关。
TGI升高独立预测65岁以下缺血性脑卒中患者3个月和12个月时的死亡。调节TGI有望成为改善年轻缺血性脑卒中患者预后的一种方法。
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