用估计葡萄糖处置率估计的胰岛素抵抗可预测急性缺血性脑卒中患者的结局。
Insulin resistance estimated by estimated glucose disposal rate predicts outcomes in acute ischemic stroke patients.
机构信息
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
出版信息
Cardiovasc Diabetol. 2023 Aug 26;22(1):225. doi: 10.1186/s12933-023-01925-1.
BACKGROUND
Estimated glucose disposal rate (eGDR), a simple and noninvasive measure of insulin resistance, has been proven to be an independent risk factor for first-time stroke and all-cause mortality. In this study, we aimed to investigate the associations between eGDR and the stroke outcome in patients with first-time acute ischemic stroke (AIS).
METHODS
We included first-time AIS patients with available data on eGDR in the China National Stroke Registry III (CNSR-III), and divided the subjects into lower eGDR group (eGDR ≤ 6 mg/kg/min) and higher eGDR group (eGDR > 6 mg/kg/min). The primary outcome was excellent functional outcome (modified Rankin Scale score 0-1) at 3 months. Secondary outcomes included stroke recurrence and favorable functional outcome (modified Rankin Scale score 0-2) at 3 months, and functional outcome and combined vascular event at one year. Univariate and multivariate analyses were performed to evaluate the association between eGDR and outcomes.
RESULTS
A total of 6,271 patients with AIS were included in this study. The median values of eGDR in lower and higher eGDR group were 5.0 mg/kg/min (interquartile range, 4.2-5.6) and 7.6 mg/kg/min (interquartile range, 6.8-9.6), respectively. Patients with higher eGDR were significantly associated with higher incidence of excellent functional outcome (adjusted odds ratio, 1.24; 95% confidence interval, 1.06-1.45; P < 0.01) at 3 months and favorable (adjusted odds ratio, 1.55; 95% confidence interval, 1.24-1.93; P < 0.01) and excellent (adjusted odds ratio, 1.28; 95% confidence interval, 1.08-1.51; P < 0.01) functional outcome at one year. However, there was no significant difference in stroke recurrence between these two groups at 3 months (adjusted odds ratio, 0.81; 95% confidence interval, 0.61-1.06; P = 0.12) and one year (adjusted odds ratio, 0.91; 95% confidence interval, 0.73-1.14; P = 0.41).
CONCLUSION
eGDR is a predictor of functional outcome in patients with AIS, independent of traditional cardiovascular predictors.
背景
估计葡萄糖处置率（eGDR）是一种简单且非侵入性的胰岛素抵抗指标，已被证明是首次中风和全因死亡率的独立危险因素。在本研究中，我们旨在探讨首次急性缺血性中风（AIS）患者的 eGDR 与中风结局之间的关系。
方法
我们纳入了中国国家卒中登记研究 III （CNSR-III）中可获得 eGDR 数据的首次 AIS 患者，并将受试者分为低 eGDR 组（eGDR≤6mg/kg/min）和高 eGDR 组（eGDR＞6mg/kg/min）。主要结局为 3 个月时的优秀功能结局（改良 Rankin 量表评分 0-1）。次要结局包括 3 个月时的中风复发和良好的功能结局（改良 Rankin 量表评分 0-2），以及 1 年时的功能结局和联合血管事件。进行单变量和多变量分析以评估 eGDR 与结局之间的关系。
结果
本研究共纳入了 6271 例 AIS 患者。低 eGDR 组和高 eGDR 组的 eGDR 中位数分别为 5.0mg/kg/min（四分位距，4.2-5.6）和 7.6mg/kg/min（四分位距，6.8-9.6）。高 eGDR 组患者在 3 个月时的优秀功能结局（调整后的优势比，1.24；95%置信区间，1.06-1.45；P<0.01）和 1 年时的良好（调整后的优势比，1.55；95%置信区间，1.24-1.93；P<0.01）和优秀（调整后的优势比，1.28；95%置信区间，1.08-1.51；P<0.01）功能结局的发生率明显更高。然而，在 3 个月（调整后的优势比，0.81；95%置信区间，0.61-1.06；P=0.12）和 1 年（调整后的优势比，0.91；95%置信区间，0.73-1.14；P=0.41）时，两组之间的中风复发率无显著差异。
结论
eGDR 是 AIS 患者功能结局的预测因素，独立于传统心血管预测因素。
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