Correlation between Triglyceride-Glucose Index and Neurological Function Impairment after Acute Ischemic Stroke

doi:10.3969/j.issn.1673-5765.2022.03.006

Abstract

Abstract:

Objective To investigate the correlation between triglyceride - glucose (TyG) index and neurological function impairment after acute ischemic stroke (AIS).

Methods The clinical data of AIS patients who were admitted to Department of Neurology, Shenzhen People's Hospital from January to May 2021 were retrospectively analyzed. Based on NIHSS score at admission, the patients were divided into three groups: without neurological deficit group (NIHSS 0), mild neurological deficit group (NIHSS 1-4) and moderate to severe neurological deficit group (NIHSS >4). ROC curve was used to evaluate the predictive value of TyG index for the severity of neurological deficits. According to the optimal cut-off value of TyG index, the patients were divided into low and high TyG index groups. The correlation between TyG index and severity of neurological deficits after AIS was analyzed using logistic regression.

Results A total of 177 AIS patients were included in this study, and there were 43 cases without neurological deficit, 85 cases with mild neurological deficit and 49 cases with moderate to severe neurological deficit. Among the three groups, there were statistical differences in the percentage of diabetes mellitus and hyperlipidemia, level of HbA1c, FPG, TG, TC, TyG index and NIHSS score (P <0.05). TyG index was positively correlated with diabetes mellitus, hyperlipidemia, level of HbA1c, FPG, TG, TC and LDL-C and NIHSS at admission, and negatively correlated with age and HDL-C level (P <0.05). The AUC of TyG index for neurological deficits was 0.70 (95%CI 0.62- 0.79, P <0.001), and the optimal cut-off value was 8.55, with the sensitivity of 69.4%, and specificity of 62.8%. Logistic regression analysis showed that the risk of neurological deficits increased by 2.03 times (OR 3.03, 95%CI 1.79-6.11, P <0.001), and the risk of moderate to severe neurological deficits increased by 4.72 times (OR 5.72, 95%CI 3.12-10.45, P <0.001), with 1 increase of TyG index in AIS patients.

Conclusions TyG index was positively correlated with the severity of neurological deficits in AIS patients.

Key words: Triglyceride-glucose index; Neurological impairment; Acute ischemic stroke; Insulin resistance

摘要：

目的探讨三酰甘油-葡萄糖（triglyceride-glucose，TyG）指数与急性缺血性卒中（acute ischemic stroke，AIS）患者神经功能缺损的相关性。

方法回顾性分析2021年1-5月于深圳市人民医院神经内科住院治疗的AIS患者的临床资料。采用 NIHSS评估AIS后神经功能缺损严重程度，根据入院时NIHSS，将入组患者分为无神经功能缺损组（0 分）、轻度神经功能缺损组（1～4分）和中重度神经功能缺损组（＞4分），比较3组患者的临床特点。应用ROC曲线评估TyG指数对神经功能缺损严重程度的预测价值，根据TyG指数最佳截断值将患者分成低TyG指数组和高TyG指数组，采用二元logistic回归分析TyG指数与AIS后神经功能缺损严重程度的关系。

结果研究共入组177例AIS患者，其中无神经功能缺损组43例、轻度神经功能缺损组85例，中重度神经功能缺损组49例。3组的糖尿病和高脂血症比例，糖化血红蛋白（glycated hemoglobin，HbA1c）、空腹血糖（fasting plasma glucose，FPG）、TG、TC水平及TyG指数等指标的差异有统计学意义。在入组的AIS患者中，TyG指数与糖尿病、高脂血症、HbA1c水平、FPG水平、TG水平、TC水平、LDL-C水平及入院NIHSS呈正相关，与年龄、HDL-C水平呈负相关。TyG指数预测神经功能缺损（NIHSS≥1分）的 AUC为0.70（95%CI 0.62～0.79，P＜0.001），最佳截断值为8.55，敏感度为69.4%，特异度为62.8%。logistic回归显示，在AIS患者中，TyG指数每增加1，发生神经功能缺损的风险性增加2.03倍（OR 3.03， 95%CI 1.79～6.11，P＜0.001），发生中重度神经功能缺损的风险性增加4.72倍（OR 5.72，95%CI 3.12～10.45，P＜0.001）。

结论 TyG指数与AIS患者神经功能缺损严重程度正相关，TyG指数升高是AIS患者神经功能缺损严重程度的独立预测因素。

关键词: 三酰甘油-葡萄糖指数; 急性缺血性卒中; 神经功能缺损; 胰岛素抵抗

HUANG Yan, FU Xuejun, SHI Huijie, ZOU Liangyu. Correlation between Triglyceride-Glucose Index and Neurological Function Impairment after Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2022, 17(03): 251-257.

黄妍, 付学军, 史会杰, 邹良玉. 三酰甘油-葡萄糖指数与急性缺血性卒中神经功能缺损的相关性分析[J]. 中国卒中杂志, 2022, 17(03): 251-257.

References

[1] 王拥军，李子孝，谷鸿秋，等. 中国卒中报告2019（中文版）（1）[J]. 中国卒中杂志，2020，15（10）：1037-1043.
[2] KERNAN W N，INZUCCHI S E，VISCOLI C M，et al. Impaired insulin sensitivity among nondiabetic patients with a recent TIA or ischemic stroke[J]. Neurology，2003，60（9）：1447-1451.
[3] GAST K B，SMIT J W，DEN HEIJER M，et al. Abdominal adiposity largely explains associations between insulin resistance，hyperglycemia and subclinical atherosclerosis：the NEO study[J]. Atherosclerosis，2013，229（2）：423-429.
[4] SLYPER A H，ROSENBERG H，KABRA A，et al. Early atherogenesis and visceral fat in obese adolescents[J]. Int J Obes（Lond），2014，38（7）：954-958.
[5] KIM M K，AHN C W，KANG S，et al. Relationship between the triglyceride glucose index and coronary artery calcification in Korean adults[J/OL]. Cardiovasc Diabetol，2017，16（1）：108[2021-12-25]. https://doi.org/10.1186/s12933-017-0589-4.
[6] HILSTED J，BONDE-PETERSEN F，NØRGAARD M B，et al. Haemodynamic changes in insulininduced hypoglycaemi a i n normal man[J ]. Diabetologia，1984，26（5）328-332.
[7] AGO T，MATSUO R，HATA J，et al. Insulin resistance and clinical outcomes after acute ischemic stroke[J/OL]. Neurology，2018，90（17）：e1470-e1477[2021-12-25]. https://doi.org/10.1212/wnl.0000000000005358.
[8] UNGER G，BENOZZI S F，PERRUZZA F，et al. Triglycerides and glucose index：a useful indicator of insulin resistance[J]. Endocrinol Nutr，2014，61（10）：533-540.
[9] GUERRERO-ROMERO F，SIMENTAL-MENDÍA L E，GONZÁLEZ-ORTIZ M，et al. The product of triglycerides and glucose，a simple measure of insulin sensitivity. Comparison with the euglycemichyperinsulinemic clamp[J]. J Clin Endocrinol Metab，2010，95（7）：3347-3351.
[10] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志，2018，51（9）：666-682.
[11] 郭啸鸣，陆珍辉，曹志勇，等. 甘油三酯-葡萄糖指数与60岁及以上脑小血管病患者血管性认知障碍的相关性分析[J]. 中华全科医师杂志，2021，20（9）：984-989.
[12] LYDEN P，BROTT T，TILLEY B，et al. Improved reliability of the NIH stroke scale using video training. NINDS TPA Stroke Study Group[J]. Stroke，1994，25（11）：2220-2226.
[13] ALBERTI K G，ZIMMET P Z. Definition，diagnosis and classification of diabetes mellitus and its complications. Part 1：diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J]. Diabet Med，1998，15（7）：539-553.

[14] JING J，PAN Y S，ZHAO X Q，et al. Insulin resistance and prognosis of nondiabetic patients with ischemic stroke：the ACROSS-China study（abnormal glucose regulation in patients with acute stroke across China）[J]. Stroke，2017，48（4）：887-893.
[15] MUNIYAPPA R，CHEN H，MONTAGNANI M，et al. Endothelial dysfunction due to selective insul i n resistance in vascular endothel ium：insights from mechanistic modeling[J/OL]. Am J Physiol Endocr inol Metab，2020，319（3）：e629-e646[2021-12-25]. https://doi.org/10.1152/ajpendo.00247.2020.
[16] CRAFT S. The role of metabolic disorders in Alzheimer disease and vascular dementia：two roads converged[J]. Arch Neurol，2009，66（3）：300-305.
[17] CERSOSIMO E，DEFRONZO R A. Insul in resistance and endothelial dysfunction：the road map to cardiovascular diseases[J]. Diabetes Metab Res Rev，2006，22（6）：423-436.
[18] CALLEJA A I，GARCÍA-BERMEJO P，CORTIJO E，et al. Insulin resistance is associated with a poor response to intravenous thrombolysis in acute ischemic stroke[J]. Diabetes Care，2011，34（11）：2413-2417.
[19] ZHANG Z Y，YAN J Q，SHI H L. Role of hypoxia inducible factor 1 in hyperglycemia-exacerbated blood-brain barrier disruption in ischemic stroke[J/OL]. Neurobiol Dis，2016，95：82-92[2021-12-25]. https://doi.org/10.1016/j.nbd.2016.07.012.
[20] 罗雪丹. 胰岛素抵抗与急性脑梗死严重程度关系研究[J]. 中国实用神经疾病杂志，2009，12（6）：3-5.
[21] FURIE K，INZUCCHI S E. Diabetes mellitus，insulin resistance，hyperglycemia，and stroke[J]. Curr Neurol Neurosci Rep，2008，8（1）：12-19.
[22] BEN-DOV I Z，BURSZTYN M. Associations of arterial stiffness indices with measures of insulin resistance and renal sodium reabsorption[J]. Am J Hypertens，2019，32（9）：810-812.
[23] KASAKURA S，MOR I T，NAKAI N，et al. Continuous blood glucose monitoring of hyperglycemia in acute stroke patients receiving enteral tube feeding[J]. Brain Nerve，2018，70（7）：849-855.
[24] PARHOFER K G. Interaction between glucose and lipid metabolism：more than diabetic dyslipidemia[J]. Diabetes Metab J，2015，39（5）：353-362.