Sun Yanli, Deng Wei, Luo Li, Chen Mingwei
Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, People's Republic of China.
Department of General Practice, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang City, Hubei Province, People's Republic of China.
Diabetes Metab Syndr Obes. 2025 Apr 25;18:1299-1309. doi: 10.2147/DMSO.S513652. eCollection 2025.
This study aims to investigate the significance of insulin resistance (IR) markers in predicting 48-hour hemorrhagic transformation and 3-month poor prognosis in acute ischemic stroke (AIS) patients of intravenous thrombolysis (IVT), with or without type 2 diabetes mellitus (T2DM).
A total of 1352 patients with AIS treated with IVT between January 2019 and December 2023 were retrospectively reviewed. We analyzed the prognostic value of IR markers, including the triglyceride-glucose (TyG) index, triglyceride and body mass index (TYG-BMI), and the insulin resistance metabolic score (METS-IR), in AIS patients who received IVT with or without T2DM. The primary outcome was 48-hour hemorrhagic transformation and 3-month poor prognosis (modified Rankin Scale [mRS] ≥ 3).
Among 1181 enrolled patients, 328 were diagnosed with T2DM, representing 27.8% of the cohort. T2DM group showed a higher proportion of poor prognosis (23% vs.11%, p < 0.001), but no significant difference in hemorrhagic transformation between the two groups. TyG index, TyG-BMI, and METS-IR all demonstrated predictive value for 3-month poor prognosis, with the TyG index showing the highest predictive accuracy [area under the curve (AUC): 0.848]. The optimal cutoff point for predicting poor prognosis was 7.409, with sensitivity of 0.762 and specificity of 0.855 (p < 0.001). However, all three indexes were limited in their ability to predict hemorrhagic transformation.
Elevated TyG index is an independent risk factor for 3-month poor prognosis in AIS patients of IVT with or without type T2DM, with the TyG index showing the highest predictive value. These findings provide a new understanding that IR can be used as a therapeutic target for AIS patients of IVT.
本研究旨在探讨胰岛素抵抗（IR）标志物在预测接受静脉溶栓（IVT）治疗的急性缺血性卒中（AIS）患者（无论是否患有2型糖尿病（T2DM））48小时内出血转化和3个月预后不良方面的意义。
回顾性分析2019年1月至2023年12月期间共1352例接受IVT治疗的AIS患者。我们分析了IR标志物，包括甘油三酯-葡萄糖（TyG）指数、甘油三酯与体重指数（TYG-BMI）以及胰岛素抵抗代谢评分（METS-IR），在接受或未接受T2DM治疗的AIS患者中的预后价值。主要结局为48小时内出血转化和3个月预后不良（改良Rankin量表[mRS]≥3）。
在1181例入组患者中，328例被诊断为T2DM，占队列的27.8%。T2DM组预后不良的比例更高（23%对11%，p<0.001），但两组间出血转化无显著差异。TyG指数、TyG-BMI和METS-IR均显示出对3个月预后不良的预测价值，其中TyG指数的预测准确性最高[曲线下面积（AUC）：0.848]。预测预后不良的最佳截断点为7.409，敏感性为0.762，特异性为0.855（p<0.001）。然而，这三个指标预测出血转化的能力均有限。
TyG指数升高是接受或未接受T2DM治疗的IVT-AIS患者3个月预后不良的独立危险因素，且TyG指数显示出最高的预测价值。这些发现为IR可作为IVT-AIS患者的治疗靶点提供了新的认识。
