非糖尿病人群颈动脉粥样硬化对血清甘油三酯葡萄糖乘积指数与无症状腔隙性脑梗死发生风险间的中介效应研究  

Mediating effect of carotid atherosclerosis on serum triglyceride-glucose index and silent lacunar infarction in non-diabetic population

作　　者：张令霞 张艳勤[2] 牛亚丽 孟翠巧[1] 于春红 聂倩[1] 刘承浩 王忠丽[1] Zhang Lingxia;Zhang Yanqin;Niu Yali;Meng Cuiqiao;Yu Chunhong;Nie Qian;Liu Chenghao;Wang Zhongli(Department of Health Examination Center,Hebei General Hospital,Shijiazhuang 050051,China;Department of Outpatient Office,Hebei General Hospital,Shijiazhuang 050051,China;Department of Imaging,Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院体检中心,石家庄050051 [2]河北省人民医院门诊办公室,石家庄050051 [3]河北省人民医院影像科,石家庄050051

出　　处：《中华神经科杂志》2024年第8期867-873,共7页Chinese Journal of Neurology

基　　金：河北省医学科学研究重点课题计划(20230267)。

摘　　要：目的探讨非糖尿病人群颈动脉粥样硬化对血清甘油三酯葡萄糖乘积(TyG)指数与无症状腔隙性脑梗死(SLI)发生风险间的中介效应。方法选择2019年1月至2021年12月于河北省人民医院体检中心参加体检者2482人作为研究对象。收集研究对象的基本信息和生化指标,计算TyG指数,测定颈动脉斑块并进行评分。采用中华医学会神经病学分会制订的标准诊断SLI,根据头颅磁共振成像(MRI)是否存在SLI将研究对象分为SLI组和非SLI组,非SLI组为正常无腔隙性脑梗死病灶者。采用Spearman相关分析探究TyG指数和颈动脉斑块评分的相关性;采用二元Logistic回归分析TyG指数和颈动脉斑块评分对SLI的影响;采用bootstrap方法分析颈动脉斑块评分是否介导了TyG指数和SLI之间的关联。结果SLI患者471例(18.98%),非SLI患者2011例(81.02%),SLI组与非SLI组相比,颈动脉斑块评分[2(0,5)分比1(0,3)分]和TyG指数[7.17(6.81,7.64)比7.12(6.77,7.54)]均升高(Z=-4.213,Z=-2.636,均P<0.05)。Spearman相关分析结果显示,颈动脉斑块评分与TyG指数呈正相关(r=0.083,P<0.001)。多因素Logistic回归分析结果显示,颈动脉斑块评分(OR=1.047,95%CI 1.002~1.094)和TyG指数(OR=1.329,95%CI 1.106~1.598)是发生SLI的独立危险因素(均P<0.05)。中介效应分析结果表明,TyG指数对SLI的发生具有直接影响(β=0.265,95%CI 0.102~0.428),并且颈动脉斑块评分部分介导了TyG指数对SLI发生的影响(β=0.024,95%CI 0.009~0.043),中介效应占总效应的8.30%。结论非糖尿病人群TyG指数和颈动脉斑块评分是SLI发生风险的预测指标,颈动脉斑块评分在TyG指数对SLI发生的影响中起部分中介作用。Objective To explore the mediating effect of carotid atherosclerosis on serum triglyceride-glucose(TyG)index and silent lacunar infarction(SLI)in non-diabetic population.Methods A total of 2482 patients were selected from the Health Examination Center of Hebei General Hospital from January 2019 to December 2021.The basic demographic information,biochemical parameters,calculated TyG index and carotid plaque score were collected.SLI was diagnosed according to the criteria formulated by Chinese Society of Neurology.Participants were divided into SLI group and non-SLI group according to whether there was SLI in brain magnetic resonance imaging,and the non-SLI group was normal without lacunar infarction.Spearman correlation analysis was used to explore the correlation between TyG index and carotid plaque score.Binary Logistic regression analysis was used to analyze the effects of TyG index and carotid plaque score on SLI.Bootstrap was used to explore whether carotid plaque score mediated the association between TyG index and SLI.Results There were 471 patients(18.98%)who had SLI,and 2011 patients(81.02%)did not.Carotid plaque score[2(0,5)vs 1(0,3)]and TyG index[7.17(6.81,7.64)vs 7.12(6.77,7.54)]were increased in the SLI group compared with the non-SLI group(Z=-4.213,Z=-2.636,P<0.05).Spearman correlation analysis showed that carotid plaque score was positively correlated with TyG index(r=0.083,P<0.001).Multivariate Logistic regression analysis indicated that carotid plaque score(OR=1.047,95%CI 1.002-1.094)and TyG index(OR=1.329,95%CI 1.106-1.598)were independent risk factors for SLI(P<0.05).Mediated effect analysis showed that TyG index had a direct effect on the incidence of SLI(β=0.265,95%CI 0.102-0.428).Carotid plaque score partially mediated the effect of TyG index on the incidence of SLI(β=0.024,95%CI 0.009-0.043),and the mediating effect accounted for 8.30%of the total effects.ConclusionIn non-diabetic population,TyG index and carotid plaque score are predictors of SLI,and the carotid plaque score is a partial

关 键 词：动脉粥样硬化 颈动脉 胰岛素抵抗 脑小血管病 腔隙性脑梗死 颈动脉粥样硬化 中介效应 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R543.5[医药卫生—临床医学]