三酰甘油-葡萄糖指数对老年缺血性脑卒中患者随访3年再发脑卒中风险的预测价值分析  

Analysis of the predictive value of triglyceride-glucose index for recurrent stroke in elderly patients with ischemic stroke

作　　者：赵洪星 张燕 马雪莲 Zhao Hongxing;Zhang Yan;Ma Xuelian(Department of Laboratory Medicine,Dongying District Peoples Hospital,Dongying 257099,China;Department of Neurology,Dongying District Peoples Hospital,Dongying 257099,China)

机构地区：[1]东营市东营区人民医院检验科,257099 [2]东营市东营区人民医院神经内科,257099

出　　处：《中国心血管杂志》2025年第1期57-62,共6页Chinese Journal of Cardiovascular Medicine

基　　金：国家高技术研究发展计划“863”计划(2014AA022304)。

摘　　要：目的探索三酰甘油-葡萄糖(TyG)指数对老年缺血性脑卒中(IS)患者随访3年再发脑卒中风险的预测价值。方法单中心、前瞻性、观察性研究。连续纳入2016年3月至2019年12月入住东营市东营区人民医院的917例老年IS患者。根据TyG的三分位数分组,包括Q_(1)组(TyG≤8.19,306例)、Q_(2)组(8.19<TyG≤8.92,306例)和Q_(3)组(TyG>8.92,305例)。患者出院后6、12、24和36个月进行随访,主要研究终点为再发脑卒中情况。Kaplan-meier生存分析比较三组的再发脑卒中情况,单因素和多因素Cox比例风险回归模型分析评估再发脑卒中的相关因素,限制性三次样条模型评估TyG指数与再发脑卒中的相关性。结果917例老年IS患者中,男性465例(50.7%),年龄60~85岁,平均(72.1±8.1)岁。Q_(1)、Q_(2)和Q_(3)组空腹血糖、餐后2 h血糖、血尿酸、血肌酐、三酰甘油、TyG和左心室质量指数比较,差异均有统计学意义(均为P<0.05)。中位随访33个月,7.6%(70/917)的患者再发脑卒中,其中Q_(1)、Q_(2)和Q_(3)组再发脑卒中分别有14例(4.6%)、19例(6.2%)和37例(12.1%);再发IS分别有9例(2.9%)、12例(3.9%)和25例(8.2%);再发出血性脑卒中有5例(1.6%)、7例(2.3%)和12例(3.9%)。Q_(1)、Q_(2)和Q_(3)组再发脑卒中发生率和再发IS发生率比较,差异均有统计学意义(Log-rankχ^(2)=5.467和9.414,P=0.031和0.007)。Kaplan-meier生存分析结果显示,经多变量校正分析后,与Q_(1)组相比,Q_(2)组(HR=1.201,95%CI:1.005~1.435,P=0.044)和Q_(3)组(HR=2.106,95%CI:1.071~4.141,P=0.031)的再发脑卒中风险均增加。多因素Cox比例风险回归模型分析结果提示,男性(HR=1.145)、吸烟史(HR=1.237)、高血压(HR=1.318)、血肌酐(HR=1.264)、TyG指数(HR=1.243)和他汀类药物(HR=0.931)是再发脑卒中的独立影响因素(均为P<0.05)。限制性三次样条回归模型显示,再发脑卒中风险与TyG指数的增加呈线性正相关(P非线性=0.643)。结论TyG指数与老年IS患者随访3年再发脑卒Objective To explore the predictive value of triglyceride-glucose(TyG)index on the risk of recurrent stroke within 3 years in el derly patients diagnosed with ischemic stroke(IS).Methods This was a single center prospective observational study.A total of 917 elderly IS patients admitted to Dongying District Peoples Hospital from March 2016 to December 2019 were consecutively included.Based on the tertiles of the TyG index,the patients were divided into three groups:Q_(1) group(TyG≤8.19,306 cases),Q_(2) group(8.19<TyG≤8.92,306 cases)and Q_(3) group(TyG>8.92,305 cases).Patients were followed up at 6,12,24 and 36 months after discharge,and the primary endpoint was recurrent stroke.Kaplan-Meier survival analysis was performed to compare recurrent stroke among the three groups.Univariate and multivariate Cox proportional hazards regression analysis was used to evaluate the related factors of recurrent stroke.A restricted cubic spline model was used to evaluate the correlation between the TyG index and recurrent stroke.Results Among the 917 elderly IS patients,465(50.7%)were male,aged 60 to 85 years,with an mean age of 72.1±8.1 years.There were statistical differences in fasting blood glucose,2-hour postprandial blood glucose,blood uric acid,serum creatinine,triglyceride,TyG index,and left ventricular mass index among the three groups(all P<0.05).After a median follow-up of 33 months,70/917(7.6%)patients had recurrent stroke.Among them,there were 14/306(4.6%),19/306(6.2%)and 37/305(12.1%)of stroke;9/306(2.9%),12/306(3.9%)and 25/305(8.2%)of recurrent IS,and 5/306(1.6%),7/306(2.3%)and 12/305(3.9%)of recurrent hemorrhagic stroke in Q_(1),Q_(2),and Q_(3) groups,respectively.The rates of all types of recurrent stroke(log-rankχ^(2)=5.467,P=0.031)and recurrent IS(log-rankχ2=9.414,P=0.007)were statistically significant among the three groups.Kaplan-Meier survival analysis showed that after multivariate correction analysis,compared with Q_(1) group,the risk of recurrent stroke in Q_(2) and Q_(3) groups were significantly

关 键 词：三酰甘油-葡萄糖指数 老年人 缺血性脑卒中 再发脑卒中 预测 

分 类 号：R74[医药卫生—神经病学与精神病学]