Liao Junqi, Zhu Yuan, Zhang Aimei, Wu Dan, Yan Xiaohui, He Qiuhua, Song Fantao, Chen Jingyi, Li Yunze, Li Li, Chen Zhaoyao, Li Wenlei, Yang Qin, Fang Zhuyuan, Wu Minghua
Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, People's Republic of China.
Department of Medicine, Physiology and Biophysics, UC Irvine Diabetes Center, University of California Irvine (UCI), Irvine, CA, USA.
Diabetes Metab Syndr Obes. 2024 Aug 13;17:3009-3018. doi: 10.2147/DMSO.S473385. eCollection 2024.
The relationship between insulin resistance-related indices and the outcomes of acute ischemic stroke (AIS) is still unclear. This study aimed to explore the association between the Apo B/Apo A-1 ratio and the Prognostic Nutritional Index (PNI) with the 90-day outcomes of AIS.
A total of 2011 AIS patients with a 3-month follow-up were enrolled in the present study from January 2017 to July 2021. Multivariate logistic regression modeling was performed to analyze the relationship between Apo B/Apo A-1 ratio, PNI, and AIS poor outcomes. The mediating effect between the three was analyzed using the Bootstrap method with PNI as the mediating variable.
Among the 2011 included AIS patients, 20.3% had a poor outcome. Patients were categorized according to quartiles of Apo B/Apo A-1 ratio and PNI. Multivariate logistic regression revealed that the fourth Apo B/Apo A-1 ratio quartile had poorer outcomes than the first quartile (OR 1.75,95%CL 1.21-2.53, P=0.003), and the fourth PNI quartile exhibited a lower risk of poor outcomes than the first quartile (OR 0.40, 95%CL 0.27-0.61, P<0.001). PNI displayed a significant partially mediating effect (21.4%) between the Apo B/Apo A-1 ratio and poor AIS outcomes.
The Apo B/Apo A-1 ratio is a risk factor for poor AIS outcomes, whereas PNI acts as a protective factor. The association between the ApoB/ApoA-1 ratio and poor AIS outcomes was partially mediated by PNI.
胰岛素抵抗相关指标与急性缺血性卒中（AIS）结局之间的关系仍不明确。本研究旨在探讨载脂蛋白B/载脂蛋白A-1比值和预后营养指数（PNI）与AIS 90天结局之间的关联。
2017年1月至2021年7月，本研究共纳入2011例有3个月随访的AIS患者。采用多因素逻辑回归模型分析载脂蛋白B/载脂蛋白A-1比值、PNI与AIS不良结局之间的关系。以PNI为中介变量，采用Bootstrap法分析三者之间的中介效应。
在纳入的2011例AIS患者中，20.3%预后不良。根据载脂蛋白B/载脂蛋白A-1比值和PNI的四分位数对患者进行分类。多因素逻辑回归显示，载脂蛋白B/载脂蛋白A-1比值的第四个四分位数的结局比第一个四分位数差（OR 1.75，95%CI 1.21-2.53，P=0.003），PNI的第四个四分位数的不良结局风险低于第一个四分位数（OR 0.40，95%CI 0.27-0.61，P<0.001）。PNI在载脂蛋白B/载脂蛋白A-1比值与AIS不良结局之间显示出显著的部分中介效应（21.4%）。
载脂蛋白B/载脂蛋白A-1比值是AIS不良结局的危险因素，而PNI是保护因素。载脂蛋白B/载脂蛋白A-1比值与AIS不良结局之间的关联部分由PNI介导。
