葡萄糖处置率对急性缺血性脑卒中合并糖尿病患者再发卒中的预测价值  

Predictive value of estimated glucose disposal rate for recurrent stroke in patients with acute ischemic stroke and diabetes

作　　者：戚纪胜[1] 范昆鹏 QI Jisheng;FAN Kunpeng(Department of Neurology The First Affiliated Hospital of Henan Science and Technology University)

机构地区：[1]河南科技大学第一附属医院神经内科,471000

出　　处：《心肺血管病杂志》2024年第11期1160-1167,共8页Journal of Cardiovascular and Pulmonary Diseases

基　　金：洛阳市科学技术项目(1920024A)。

摘　　要：目的:探究葡萄糖处置率(estimated glucose disposal rate,eGDR)对急性缺血性脑卒中合并糖尿病患者再发卒中的预测价值。方法:研究共纳入2021年1月1日至2023年1月1日,在河南科技大学第一附属医院因急性缺血性脑卒中住院且合并糖尿病的745例患者,并根据eGDR四分位数分为四组,进行为期12个月的随访。研究终点为随访期间的再发缺血性脑卒中。通过单因素及多因素COX回归分析探究eGDR对再发卒中的影响,并绘制Kaplan–Meier生存分析曲线。采用森林图展示亚组分析的结果。绘制限制性立方样条图(RCS)直观反映eGDR与再发卒中之间的关系。结果:随着eGDR的增高,患者再发卒中发生率显著降低[组1 vs.组2vs.组3 vs.组4:28(15.0%)vs.16(8.6%)vs.13(7.0%)vs.11(5.9%)]。Kaplan–Meier生存分析表明,随着eGDR四分位数增高,再发卒中发生率明显降低(Logrank test,P=0.010)。多因素COX回归分析表明:随着eGDR四分位数的增高,组2-4再发卒中的风险显著降低(以组1为参照,组4 HR=0.433,95%CI:0.209~0.898,P=0.025)。RCS表明eGDR与再发卒中呈线性关系,再发卒中风险随着eGDR的上升而降低。亚组分析未观察到显著的交互作用。结论:eGDR是急性缺血性脑卒中合并糖尿病患者再发卒中的独立预测因素。随着eGDR的升高,再发卒中发生率显著降低。Objective:To investigate the predictive value of estimated glucose disposal rate(eGDR)for recurrent stroke in patients with acute ischemic stroke(AIS)and diabetes.Methods:A total of 745 diabetic patients admitted to at the First Affiliated Hospital of Henan University of Science and Technology due to AIS from January 1st,2021 to January 1st,2023 were included in the study.Patients were categorized into four groups based on quartiles of eGDR and followed up for 12 months.The primary endpoint was the occurrence of recurrent ischemic stroke during the follow-up period.Univariate and multivariate Cox regression analyses were conducted to explore the impact of eGDR on recurrent stroke,and Kaplan-Meier survival curves were plotted.Forest plots were used to display the results of subgroup analyses.Restricted cubic spline(RCS)was constructed to present the linear relation between eGDR and recurrent stroke.Results:As eGDR increased,the incidence of recurrent stroke significantly decreased[Group 1 vs.Group 2 vs.Group 3 vs.Group 4:28(15.0%)vs.16(8.6%)vs.13(7.0%)vs.11(5.9%)].Kaplan-Meier analysis showed that the incidence of the recurrent stroke decreased gradually with rising eGDR quartiles(log-rank test,P=0.010).Multivariate Cox regression analysis revealed that compared with the lowest eGDR quartile,the top eGDR quartile was associated with significantly reduced risk of recurrent stroke(HR=0.433,95%CI:0.209-0.898,P=0.025).RCS demonstrated a linear relationship between eGDR and recurrent stroke,with a decreasing risk of recurrent stroke as eGDR increased.No significant interaction was observed in subgroup analysis.Conclusion:eGDR is an independent predictive factor for recurrent stroke in patients with AIS and diabetes.As eGDR increased,the risk of recurrent stroke was significantly decreased.

关 键 词：急性缺血性脑卒中 糖尿病 再发卒中 葡萄糖处置率 

分 类 号：R54[医药卫生—心血管疾病]