Rong Ning, Li Zhi-Wei, Yuan Jian, Shao Ze-Min, Deng Yun, Zhu De-Sheng, Sun Zhong-Wu
Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People's Republic of China.
Department of Neurology, Baoshan Branch, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200444, People's Republic of China.
J Inflamm Res. 2024 Sep 4;17:6039-6050. doi: 10.2147/JIR.S471841. eCollection 2024.
Fasting blood glucose (FBG) is a recognized risk factor for Ischemic Stroke, but little research has examined the interaction among FBG, Platelet Distribution Width (PDW) and the severity of neuronal damage. Thus, the present study constructs a moderated mediation model aimed to elucidate the relationships among FBG, PDW, and NIHSS scores in patients with acute ischemic stroke (AIS).
We conducted a cross-sectional study on 431 AIS patients. Upon hospital admission, we assessed the patients' NIHSS scores and collected blood samples to measure FBG and PDW levels. The relationship between FBG and NIHSS scores moderated by PDW was analyzed by linear curve fitting analysis, multiple linear regression analysis, and moderated mediation analysis respectively.
In the tertile grouping based on FBG, both PDW and NIHSS scores of AIS patients demonstrated an increase corresponding with rising levels of FBG (<0.001 for both). Multiple linear regression analysis revealed that, the coefficients (95% CI) for the relationship between FBG and NIHSS scores were 1.49 (1.27-1.71, <0.01) post-adjustment for potential confounders. The coefficients (95% CI) for the relationship between FBG and PDW were 0.02 (0.01-0.04, <0.01) post-adjustment. Likewise, for the relationship between PDW and NIHSS scores, the coefficients (95% CI) were 4.33 (3.07-5.59, <0.01) after adjustment. These positive association remained consistent in sensitivity analysis and hierarchical analysis. Smoothed plots suggested that there are linear relationships between FBG and PDW and NIHSS scores respectively. Further mediation analysis indicated that increased PDW significantly (<0.01) mediated 5.91% of FBG-associated increased NIHSS scores.
This study suggested that FBG levels were associated with NIHSS scores, and the FBG-associated neurological impairment may be partially mediated by PDW. These findings underscore the importance of monitoring FBG and PDW levels in AIS patients, potentially guiding risk intervention strategies.
空腹血糖（FBG）是公认的缺血性卒中危险因素，但很少有研究探讨FBG、血小板分布宽度（PDW）与神经元损伤严重程度之间的相互作用。因此，本研究构建了一个有调节的中介模型，旨在阐明急性缺血性卒中（AIS）患者中FBG、PDW和美国国立卫生研究院卒中量表（NIHSS）评分之间的关系。
我们对431例AIS患者进行了横断面研究。入院时，我们评估了患者的NIHSS评分，并采集血样以测量FBG和PDW水平。分别通过线性曲线拟合分析、多元线性回归分析和有调节的中介分析，分析了由PDW调节的FBG与NIHSS评分之间的关系。
在基于FBG的三分位数分组中，AIS患者的PDW和NIHSS评分均随FBG水平升高而升高（两者均P<0.001）。多元线性回归分析显示，在对潜在混杂因素进行调整后，FBG与NIHSS评分之间关系的系数（95%CI）为1.49（1.27-1.71，P<0.01）。调整后FBG与PDW之间关系的系数（95%CI）为0.02（0.01-0.04，P<0.01）。同样，对于PDW与NIHSS评分之间的关系，调整后的系数（95%CI）为4.33（3.07-5.59，P<0.01）。这些正相关在敏感性分析和分层分析中保持一致。平滑图表明FBG与PDW以及NIHSS评分之间分别存在线性关系。进一步的中介分析表明，PDW升高显著（P<0.01）介导了FBG相关的NIHSS评分升高的5.91%。
本研究提示FBG水平与NIHSS评分相关，且FBG相关的神经功能损害可能部分由PDW介导。这些发现强调了监测AIS患者FBG和PDW水平的重要性，可能为风险干预策略提供指导。
