Effect of Insulin Resistance on Prognosis of Intravenous Thrombolysis in Acute Ischemic Stroke Patients with or Without Type 2 Diabetes Mellitus.

IF 2.8 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy Pub Date : 2025-04-25 eCollection Date: 2025-01-01 DOI:10.2147/DMSO.S513652

Yanli Sun, Wei Deng, Li Luo, Mingwei Chen

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Abstract

Introduction: This study aims to investigate the significance of insulin resistance (IR) markers in predicting 48-hour hemorrhagic transformation and 3-month poor prognosis in acute ischemic stroke (AIS) patients of intravenous thrombolysis (IVT), with or without type 2 diabetes mellitus (T2DM).

Methods: A total of 1352 patients with AIS treated with IVT between January 2019 and December 2023 were retrospectively reviewed. We analyzed the prognostic value of IR markers, including the triglyceride-glucose (TyG) index, triglyceride and body mass index (TYG-BMI), and the insulin resistance metabolic score (METS-IR), in AIS patients who received IVT with or without T2DM. The primary outcome was 48-hour hemorrhagic transformation and 3-month poor prognosis (modified Rankin Scale [mRS] ≥ 3).

Results: Among 1181 enrolled patients, 328 were diagnosed with T2DM, representing 27.8% of the cohort. T2DM group showed a higher proportion of poor prognosis (23% vs.11%, p < 0.001), but no significant difference in hemorrhagic transformation between the two groups. TyG index, TyG-BMI, and METS-IR all demonstrated predictive value for 3-month poor prognosis, with the TyG index showing the highest predictive accuracy [area under the curve (AUC): 0.848]. The optimal cutoff point for predicting poor prognosis was 7.409, with sensitivity of 0.762 and specificity of 0.855 (p < 0.001). However, all three indexes were limited in their ability to predict hemorrhagic transformation.

Conclusion: Elevated TyG index is an independent risk factor for 3-month poor prognosis in AIS patients of IVT with or without type T2DM, with the TyG index showing the highest predictive value. These findings provide a new understanding that IR can be used as a therapeutic target for AIS patients of IVT.

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胰岛素抵抗对合并或不合并2型糖尿病的急性缺血性脑卒中患者静脉溶栓预后的影响。

前言：本研究旨在探讨胰岛素抵抗（IR）标志物在急性缺血性脑卒中（AIS）静脉溶栓（IVT）患者48小时出血转化和3个月不良预后预测中的意义，伴或不伴2型糖尿病（T2DM）。方法：回顾性分析2019年1月至2023年12月期间接受IVT治疗的1352例AIS患者。我们分析了IR标志物，包括甘油三酯-葡萄糖（TyG）指数、甘油三酯和体重指数（TyG - bmi）以及胰岛素抵抗代谢评分（METS-IR）在接受IVT合并或不合并T2DM的AIS患者中的预后价值。主要结局为48小时出血转化，3个月预后不良（改良Rankin量表[mRS]≥3）。结果：在1181例入组患者中，328例被诊断为T2DM，占队列的27.8%。T2DM组预后不良比例较高（23%比11%，p < 0.001），但两组出血转化无显著差异。TyG指数、TyG- bmi、met - ir对3个月不良预后均有预测价值，其中TyG指数预测准确率最高[曲线下面积（AUC）： 0.848]。预测不良预后的最佳截断点为7.409，敏感性为0.762，特异性为0.855 （p < 0.001）。然而，这三个指标在预测出血转化的能力上都是有限的。结论：TyG指数升高是伴有或不伴有T2DM的AIS IVT患者3个月预后不良的独立危险因素，其中TyG指数预测价值最高。这些发现提供了一个新的认识，即IR可以作为AIS患者IVT的治疗靶点。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy Pharmacology, Toxicology and Pharmaceutics-Pharmacology

CiteScore

5.90

自引率

6.10%

发文量

431

审稿时长

16 weeks

期刊介绍： An international, peer-reviewed, open access, online journal. The journal is committed to the rapid publication of the latest laboratory and clinical findings in the fields of diabetes, metabolic syndrome and obesity research. Original research, review, case reports, hypothesis formation, expert opinion and commentaries are all considered for publication.