Homeostasis model assessment of insulin resistance in relation to the poor functional outcomes in nondiabetic patients with ischemic stroke
Homeostasis model assessment of insulin resistance in relation to the poor functional outcomes in nondiabetic patients with ischemic stroke
复制标题
胰岛素抵抗的稳态模型评估与缺血性中风的非糖尿病患者不良功能结果的关系
DOI：
10.1042/bsr20180330
复制
发表时间：
2018-05-15
影响因子：
4
通讯作者：
Qiao, Hong
中科院分区：
文献类型：
--
作者：
Li, Siou;Yin, Changhao;Qiao, Hong
胰岛素抵抗(IR)是否预示着缺血性卒中患者更差的功能结局仍是一个有争议的问题。本研究的目的是在173例中国非糖尿病急性缺血性卒中患者中确定胰岛素抵抗与不良预后风险之间的关系。这是一项基于人群的前瞻性队列研究。胰岛素敏感性，用胰岛素敏感性的稳态模型评估(HOMA指数=(空腹胰岛素×空腹血糖)/22.5)表示。IR由HOMA-IR指数定义在上四分位(Q4)。出院时使用改良Rankin评分(MRS)评估功能损害。HOMA-IR的中位数(四分位数范围)为2.14(1.17-2.83)，Q4至少为2.83。HOMA-IR与美国国立卫生研究院卒中评分呈显著正相关(r=0.408；P<；0.001)。在多因素分析中，IR组患者发生功能不良的风险较高(OR=3.23；95%可信区间(CI)=1.75~5.08；P=0.001)。在比较HOMA-IR的第三和第四四分位数与第一四分位数的多变量模型中，HOMA-IR水平与不良结局相关，调整后的不良结局风险分别增加207%(OR=3.0595%CI1.70-4.89P=0.006)和429%(5.29%(3.059.80)，P<；0.001)。在不良预后的受试者操作特征曲线(ROC)分析中，将HOMA-IR加入临床检查变量后，曲线下面积(AUC)从0.80增加到0.84(95%CI：0.79~0.88)(P=0.02)。高HOMA-IR指数与非糖尿病急性缺血性卒中患者的功能预后不良有关。
Whether insulin resistance (IR) predicts worse functional outcome in ischemic stroke is still a matter of debate. The aim of the present study is to determine the association between IR and risk of poor outcome in 173 Chinese nondiabetic patients with acute ischemic stroke. This is a prospective, population-based cohort study. Insulin sensitivity, expressed by the homeostasis model assessment (HOMA) of insulin sensitivity (HOMA index = (fasting insulin × fasting glucose)/22.5). IR was defined by HOMA-IR index in the top quartile (Q4). Functional impairment was evaluated at discharge using the modified Rankin scale (mRS). The median (interquartile range) HOMA-IR was 2.14 (1.17–2.83), and Q4 was at least 2.83. There was a significantly positive correlation between HOMA-IR and National Institutes of Health Stroke Scale (r = 0.408; P<0.001). In multivariate analyses, patients in IR group were associated with a higher risk of poor functional outcome (odds ratio (OR) = 3.23; 95% confidence interval (CI) = 1.75–5.08; P=0.001). In multivariate models comparing the third and fourth quartiles against the first quartile of the HOMA-IR, levels of HOMA-IR were associated with poor outcome, and the adjusted risk of poor outcome increased by 207% (OR = 3.05 (95% CI 1.70–4.89), P=0.006) and 429% (5.29 (3.05–9.80), P<0.001). In a receiver operating characteristic curve (ROC) analysis of poor outcome, the area under the curve (AUC) increased from 0.80 to 0.84 (95% CI: 0.79–0.88) by adding HOMA-IR to clinical examination variables (P=0.02). High HOMA-IR index is associated with a poor functional outcome in nondiabetic patients with acute ischemic stroke.