Zhongguo cuzhong zazhi (Oct 2019)

胰岛素抵抗与非致残性缺血性脑血管病患者卒中复发之间的关系 Association between Insulin Resistance and Recurrent Stroke in Patients with Non-disabling Ischemic Cerebrovascular Events

  • 陈玮琪，张国军，潘岳松，林金嬉，梁宪红，李上智，王伊龙，荆京，赵性泉，刘丽萍，王拥军

DOI
https://doi.org/10.3969/j.issn.1673-5765.2019.10.008
Journal volume & issue
Vol. 14, no. 10
pp. 1004 – 1010

Abstract

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目的 探讨不同胰岛素抵抗状态对无糖尿病史的非致残性缺血性脑血管病（non-disabling ischemic cerebrovascular events，NICE）患者卒中复发风险的影响。 方法 使用稳态模型胰岛素抵抗（homeostasis model assessment of insulin resistance，HOMA-I R）指数 对胰岛素抵抗进行评估。根据不同胰岛素抵抗状态，使用四分位法将无糖尿病史的NICE患者分为4 组。该研究的主要研究终点为90 d新发卒中（包括缺血性和出血性卒中）。利用多元Cox回归模型校正 潜在协变量，评估不同胰岛素抵抗状态与卒中复发风险之间的关系，同时对不同抗血小板聚集治疗、 不同胰岛素抵抗状态与卒中复发之间的交互作用进行统计分析。 结果 本研究共纳入2325例NICE患者。根据患者不同胰岛素抵抗状态分组，4组界值分别为Q1 （HOMA-IR指数﹤1.35）、Q2（1.35≤HOMA-IR指数﹤2.17）、Q3（2.17≤HOMA-IR指数﹤3.39）及Q4（HOMAIR 指数≥3.39），4组患者人数分别为585例、575例、585例及580例。90 d随访时，共出现167例卒中复 发，其中氯吡格雷联合阿司匹林组为68例，阿司匹林组为99例。与Q1组（6.3%）比较，Q2组（9.2%，校 正HR 1.56，95%CI 1.01～2.41，P =0.04）、Q3组（5.6%，校正HR 1.04，95%CI 0.64～1.69，P =0.89）和 Q4组（7.6%，校正HR 1.35，95%CI 0.85～2.15，P =0.21）患者卒中复发风险均未明显上升。 结论 本研究未在NICE患者中发现胰岛素抵抗与卒中复发风险升高相关。 Abstract: Objective To explore the effect of different insulin resistance state on the prognosis of patients with non-disabling ischemic cerebrovascular events (NICE). Methods The homeostasis model HOMA-IR index was used to evaluate insulin resistance. According to different insulin resistance status, patients were divided into four groups by quartile method. The primary endpoint was 90-day new-onset stroke (including ischemic and hemorrhagic stroke). Multivariate Cox regression model was used to assess the relationship between different insulin resistance status and recurrent stroke. The interaction between different antiplatelet therapeutic regimen and different insulin resistance status on recurrent stroke was also analyzed. Results A total of 2325 NICE patients were enrolled in this study. According to different insulin resistance status, all patients were divided into 4 groups: Q1 (HOMA-IR index <1.35), Q2 (1.35≤ HOMA-IR index <2.17), Q3 (2.17≤ HOMA-IR index <3.39) and Q4 (HOMA-IR index ≥3.39) group. The number of patients in Q1, Q2, Q3 and Q4 group were 585, 575, 585 and 580,respectively. Within 90 days of follow-up, recurrent stroke occurred in 167 patients, including 68 ones in clopidogrel combined with aspirin group and 99 ones in aspirin group. The risk of recurrent stroke in Q2 group (9.2% vs 6.3%; adjusted HR 1.56, 95%CI 1.01-2.41; P =0.04), Q3 group (5.6% vs 6.3%; adjusted HR 1.04, 95%CI 0.64-1.69; P =0.89) and Q4 group (7.6% vs 6.3%; adjusted HR 1.35, 95%CI 0.85-2.15; P =0.21) all did not increase significantly compared with that in Q1 group. Conclusions Insulin resistance is not associated with an increased risk of recurrent stroke in patients with mild stroke and TIA.

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