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山东大学学报 (医学版) ›› 2024, Vol. 62 ›› Issue (8): 93-100.doi: 10.6040/j.issn.1671-7554.0.2024.0659

• • 上一篇    

甘油三酯-葡萄糖指数与颅内动脉粥样硬化性狭窄的相关性

刘淋1,2,3,王晓楠4,杨雅溪1,2,3,王江腾1,2,3,李旭1,2,3,周新丽1,2,3,管庆波1,2,3,张栩1,2,3   

  • 发布日期:2024-09-20
  • 通讯作者: 张栩. E-mail:zhangxu@medmail.com.cn

Correlation of triglycride-glucose index and atherosclerotic stenosis in intracranial arteries

LIU Lin1,2,3, WANG Xiaonan4, YANG Yaxi1,2,3, WANG Jiangteng1,2,3, LI Xu1,2,3, ZHOU Xinli1,2,3, GUAN Qingbo1,2,3, ZHANG Xu1,2,3   

  1. 1. Key Laboratory of Endocrine Glucose &
    Lipids Metabolism and Brain Aging, Ministry of Education;
    Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China;
    2. Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan 250021, Shandong, China;
    3. Shandong Institute of Endocrine and Metabolic Diseases, Jinan 250021, Shandong, China;
    4. Department of Endocrinology and Nephrology, Boxing County Peoples Hospital, Boxing 256500, Shandong, China
  • Published:2024-09-20

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摘要： 目的 探讨甘油三酯葡萄糖(triglycride-glucose, TyG)指数与急性缺血性脑卒中(acute ischemic stroke, AIS)患者颅内动脉粥样硬化性狭窄(intracranial atherosclerotic stenosis, ICAS)之间的关联,并评估TyG指数在预测AIS患者发生ICAS中的应用价值。 方法 选取2021年12月至2023年12月山东省立医院神经内科住院AIS患者380例。根据数字减影血管造影(digital subtraction angiography, DSA)结果分为对照组(n=116)和狭窄组(n=264),收集两组病史、身高、体质量、血压等基本资料,检测甘油三酯(triglyceride, TG)、空腹血糖(fasting plasma glucose, FPG)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol, LDL-c)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol, HDL-c)、总胆固醇(total cholesterol, TC)等指标。采用多因素Logistic回归分析AIS患者发生ICAS的危险因素。采用受试者工作特征(receiver operator characteristic, ROC)曲线评估TyG指数对AIS患者发生ICAS的预测价值。 结果 狭窄组高血压病史、糖尿病史、收缩压、舒张压、体质量指数(body mass index, BMI)、TG、FPG、TyG指数较对照组升高,差异有统计学意义(P<0.05)。AIS患者ICAS的检出率随TyG指数三分位数增加而升高(P<0.05)。Spearman相关性分析显示,AIS患者ICAS与高血压史、糖尿病史、收缩压、舒张压、BMI、FPG、TG、TyG指数呈正相关(r分别为0.189、0.273、0.157、0.175、0.142、0.400、0.290、0.431,P<0.05),与HDL-c呈负相关(r为-0.248,P<0.05)。二分类Logistic回归分析显示,TyG指数是ICAS的独立影响因素(OR=10.829,95%CI:5.179~22.641,P<0.05),HDL-c(OR=0.269,95%CI:0.141~0.514,P<0.05)是ICAS的保护因素。ROC曲线显示,对于预测AIS患者ICAS,TyG指数的曲线下面积为0.777(95%CI:0.723~0.830,P<0.05),当TyG指数取最佳截断值8.625时,对应的灵敏度为0.811,特异度为0.629。 结论 TyG指数与AIS患者ICAS相关,并且高TyG指数可能是AIS患者ICAS的独立危险因素。TyG指数对AIS患者ICAS具有一定的预测价值。

关键词: 颅内动脉狭窄, 缺血性脑卒中, 胰岛素抵抗, 甘油三酯葡萄糖指数

Abstract: Objective To investigate the association between the triglyceride-glucose(TyG)index and intracranial atherosclerotic stenosis(ICAS)in patients with acute ischaemic stroke(AIS). and to assess the value of the application of TyG index in predicting the occurrence of ICAS in AIS patients. Methods A total of 380 patients with AIS admitted to the Department of Neurology, Shandong Provincial Hospital from December 2021 to December 2023 were selected. They were divided into control group(n=116)and stenosis group(n=264)according to the results of digital subtraction angiography(DSA). Baseline data such as medical history, height, body weight, blood pressure, etc., were collected from both groups. Indices such as triglycerides(TG), fasting plasma glucose(FPG), low-density lipoprotein cholesterol(LDL-c), high-density lipoprotein cholesterol(HDL-c)and total cholesterol(TC)were measured. Multifactorial Logistic regression was used to analyse the risk factors for ICAS in AIS patients. The predictive value of the TyG index for the occurrence of ICAS in patients with AIS was assessed using the receiver operating characteristic(ROC)curve. Results History of hypertension, history of diabetes mellitus, systolic blood pressure, diastolic blood pressure, BMl, TG, FPG and TyG index were increased in the stenosis group compared with the control group, and the difference was statistically significant(P<0.05).The detection rate of ICAS in patients with AIS increased with the increase in tertile of TyG index(P<0.05). Spearmans correlation analysis showed that ICAS and history of hypertension, history of diabetes mellitus, systolic blood pressure, diastolic blood pressure, BMl, FPG, TG and TyG index were positively correlated(r values were 0.189,0.273,0.157,0.175,0.142,0.400,0.290 and 0.431, respectively, P<0.05), while ICAS and HDL-c was negatively correlated(r=-0.248, P<0.05). Two-category Logistic regression analysis showed that TyG index had an independent influence on ICAS(OR=10.829, 95%CI: 5.179-22.641, P<0.05), and HDL-c(OR=0.269,95%CI: 0.141-0.514, P<0.05)was a protective factor against ICAS. The ROC curve showed that, the area under the curve of TyG index was 0.777(95%CI: 0.723-0.830, P<0.05), which corresponded to a sensitivity of 0.811 and a specificity of 0.629 when the optimal cut-off value of TyG index was 8.625. Conclusion TyG index is associated with ICAS in AIS patients, and high TyG index may be an independent risk factor for ICAS in AIS patients.TyG index has some predictive value for ICAS in AIS patients.

Key words: Intracranial artery stenosis, Ischaemic stroke, Insulin resistance, Triglyceride-glucose index

中图分类号: 

  • R58
[1] Feigin VL, Brainin M, Norrving B, et al. World stroke organization(WSO): global stroke fact sheet 2022[J]. Int J Stroke, 2022, 17(1): 18-29.
[2] Gutierrez J, Turan TN, Hoh BL, et al. Intracranial atherosclerotic stenosis: risk factors, diagnosis, and treatment[J]. Lancet Neurol, 2022, 21(4): 355-368.
[3] Vasques AC, Novaes FS, de Oliveira Mda S, et al. TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study[J]. Diabetes Res ClinPract, 2011, 93(3): e98-e100.
[4] Yang Y, Huang X, Wang Y, et al. The impact of triglyceride-glucose index on ischemic stroke: a systematic review and meta-analysis[J]. Cardiovasc Diabetol, 2023, 22(1): 2.
[5] Feigin VL, Owolabi MO,World Stroke Organization-Lancet Neurology Commission Stroke Collaboration Group. Pragmatic szolutions to reduce the global burden of stroke: a World stroke organization-lancet neurology commission[J]. Lancet Neurol, 2023, 22(12): 1160-1206.
[6] Wang M, Mei L, Jin A, et al. Association between triglyceride glucose index and atherosclerotic plaques and Burden: findings from a community-based study[J]. Cardiovasc Diabetol, 2022, 21(1): 204.
[7] Miao M, Zhou G, Bao A, et al. Triglyceride-glucose index and common carotid artery intima-media thickness in patients with ischemic stroke[J]. Cardiovasc Diabetol, 2022, 21(1): 43.
[8] Cai B, Peng B. Intracranial artery stenosis: current status of evaluation and treatment in China[J]. Chronic Dis Transl Med, 2017, 3(4): 197-206.
[9] 钟迪,张舒婷,吴波. 《中国急性缺血性脑卒中诊治指南2018》解读[J].中国现代神经疾病杂志, 2019, 19(11): 897-901. ZHONG Di, ZHANG Shuting, WU Bo. Interpretation of “Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018”[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2019, 19(11): 897-901.
[10] Samuels OB, Joseph GJ, Lynn MJ, et al. A standardized method for measuring intracranial arterial stenosis[J]. AJNR Am J Neuroradiol, 2000, 21(4): 643-646.
[11] Park K, Ahn CW, Lee SB, et al. Elevated TyG index predicts progression of coronary artery calcification[J]. Diabetes Care, 2019, 42(8): 1569-1573.
[12] Zhao Y, Sun H, Zhang W, et al. Elevated triglyceride-glucose index predicts risk of incident ischaemic stroke: the Rural Chinese cohort study[J]. Diabetes Metab, 2021, 47(4): 101246.
[13] Liang CP, Han S, Senokuchi T, et al. The macrophage at the crossroads of insulin resistance and atherosclerosis[J]. Circ Res, 2007, 100(11): 1546-1555.
[14] Farhan S, Redfors B, Maehara A, et al. Relationship between insulin resistance, coronary plaque, and clinical outcomes in patients with acute coronary syndromes: an analysis from the PROSPECT study[J]. Cardiovasc Diabetol, 2021, 20(1): 10.
[15] Cersosimo E, Solis-Herrera C, Trautmann ME, et al. Assessment of pancreatic β-cell function: review of methods and clinical applications[J]. Curr Diabetes Rev, 2014, 10(1): 2-42.
[16] Kim GR, Choi DW, Nam CM, et al. Synergistic association of high-sensitivity C-reactive protein and body mass index with insulin resistance in non-diabetic adults[J]. Sci Rep, 2020, 10: 18417. doi:10.1038/s41598-020-75390-1.
[17] Zhang Y, Ding XS, Hua B, et al. Predictive effect of triglycerideglucose index on clinical events in patients with type 2 diabetes mellitus and acute myocardial infarction: results from an observational cohort study in China[J]. Cardiovasc Diabetol, 2021, 20(1): 43.
[18] Tao LC, Xu JN, Wang TT, et al. Triglyceride-glucose index as a marker in cardiovascular diseases: landscape and limitations[J]. Cardiovasc Diabetol, 2022, 21(1): 68.
[19] Zhao S, Yu S, Chi C, et al. Association between macro- and microvascular damage and the triglyceride glucose index in community-dwelling elderly individuals: the Northern Shanghai Study[J]. Cardiovasc Diabetol, 2019, 18(1): 95.
[20] 白彦琳,梁士楚,王翠,等. 甘油三酯葡萄糖指数和动脉硬化相关性的Meta分析[J].中国循证医学杂志, 2024, 24(7): 797-805. BAI Yanlin, LIANG Shichu, WANG Cui, et al. Triglyceride-glucose index and arterial stiffness: a meta-analysis[J]. Chinese Journal of Evidence-Based Medicine, 2024, 24(7): 797-805.
[21] Sánchez-Íñigo L, Navarro-González D, Fernández-Montero A, et al. The TyG index may predict the development of cardiovascular events[J]. Eur J Clin Invest, 2016, 46(2): 189-197.
[22] Ding X, Wang X, Wu J, et al. Triglyceride-glucose index and the incidence of atherosclerotic cardiovascular diseases: a meta-analysis of cohort studies[J]. Cardiovasc Diabetol, 2021, 20(1): 76.
[23] Yu H, Tao L, Li YG, et al. Association between triglyceride-glucose index trajectories and carotid atherosclerosis progression[J]. Cardiovasc Diabetol, 2023, 22(1): 130.
[24] 张彤,田雪,左颖婷,等. 无传统危险因素人群中TyG指数与心脑血管疾病的关系[J].上海交通大学学报(医学版), 2022, 42(3): 267-274. ZHANG Tong, TIAN Xue, ZUO Yingting, et al.Association of triglyceride-glucose index with cardiovascular disease in peoplewithout traditional risk factors[J]. Journal of Shanghai Jiao Tong University(Medical Science), 2022, 42(3): 267-274.
[25] Yang WS, Li R, Shen YQ, et al. Importance of lipid ratios for predicting intracranial atherosclerotic stenosis[J]. Lipids Health Dis, 2020, 19(1): 160.
[26] López-Cancio E, Galán A, Dorado L, et al. Biological signatures of asymptomatic extra- and intracranial atherosclerosis: the Barcelona-AsIA(Asymptomatic Intracranial Atherosclerosis)study[J]. Stroke, 2012, 43(10): 2712-2719.
[27] 殷为勇,王香云,肖美娟,等. 甘油三酯葡萄糖指数与颅内动脉粥样硬化性狭窄的研究[J].中国现代医生, 2016, 54(4): 12-14. YIN Weiyong, WANG Xiangyun, XIAO Meijuan, et al. Study on the correlation between triglyceride and glucose indices and in tracranial and extracranial atherosclerotic stenosis[J]. China Modern Doctor, 2016, 54(4): 12-14.
[28] Wang Y, Liu T, Li Y, et al. Triglyceride-glucose index, symptomatic intracranial artery stenosis and recurrence risk in minor stroke patients with hypertension [J]. Cardiovasc Diabetol, 2023, 22(1): 90.
[29] Wang AX, Tian X, Zuo YT, et al. Association of triglyceride-glucose index with intra- and extra-cranial arterial stenosis: a combined cross-sectional and longitudinal analysis[J]. Endocrine, 2021, 74(2): 308-317.
[30] 罗伟刚,刘万虎,尹园园,等. 甘油三酯-葡萄糖指数与缺血性脑卒中的研究进展[J]. 中风与神经疾病杂志, 2023, 40(12): 1140-1144. LUO Weigang, LIU Wanhu, YIN Yuanyuan, et al. Research advances in the value of triglyceride-glucose index in ischemic stroke[J]. Journal of Apoplexy and Nervous Diseases, 2023, 40(12): 1140-1144.
[31] Cho KH. The current status of research on high-density lipoproteins(HDL): a paradigm shift from HDL quantity to HDL quality and HDL functionality[J]. Int J Mol Sci, 2022, 23(7): 3967.
[32] von Eckardstein A, Nordestgaard BG, Remaley AT, et al. High-density lipoprotein revisited: biological functions and clinical relevance[J]. Eur Heart J, 2023, 44(16): 1394-1407.
[33] Liu Y, Song JH, Hou XH, et al. Elevated homocysteine as an independent risk for intracranial atherosclerotic stenosis[J]. Aging(Albany NY), 2019, 11(11): 3824-3831.
[34] Li HQ, Wang X, Wang HF, et al. Dose-response relationship between blood pressure and intracranial atherosclerotic stenosis[J]. Atherosclerosis, 2021, 317: 36-40. doi: 10.1016/j.atherosclerosis.2020.12.004.
[35] Xie Y, Cen K, Dan B, et al. Association between triglyceride-glucose index and intracranial/extracranial atherosclerotic stenosis: findings from a retrospective study[J]. Cardiovasc Diabetol, 2024, 23(1): 95.
[36] Niu YN, Guo C, Guo XZ, et al. High-resolution magnetic resonance imaging investigation of the connection between the triglyceride-glucose index and intracranial arterial remodeling: a retrospective cross-sectional study[J]. Quant Imaging Med Surg, 2023, 13(12): 8504-8516.
[37] Yaghi S, Furie KL, Viscoli CM, et al. IRIS trial investigators. Pioglitazone prevents stroke in patients with a recent transient ischemic attack or ischemic stroke: a planned secondary analysis of the IRIS trial(Insulin Resistance Intervention After Stroke)[J]. Circulation, 2018, 137(5): 455-463.
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