Value of triglyceride-glucose index for the estimation of ischemic stroke risk: Insights from a general population
Value of triglyceride-glucose index for the estimation of ischemic stroke risk: Insights from a general population
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甘油三酯-葡萄糖指数对于估计缺血性中风风险的价值：来自一般人群的见解
DOI：
10.1016/j.numecd.2019.09.015
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发表时间：
2020-02-10
影响因子：
3.9
通讯作者：
Liu, Shuang
中科院分区：
文献类型：
--
作者：
Shi, Wenrui;Xing, Liying;Liu, Shuang
背景和目的：近年来的研究已经认识到甘油三酯-葡萄糖指数（TyG）是胰岛素抵抗的实用替代指标。先前的研究表明，胰岛素抵抗通过多种机制参与缺血性卒中。本研究旨在探讨TyG与缺血性脑卒中患病率的关系，探讨TyG在优化缺血性脑卒中风险分层中的价值。方法与结果：本横断面研究纳入2017年9月至2018年5月来自中国东北农村地区的10,900名受试者（平均年龄：59.95岁，女性59.8%）。TyG计算为ln[空腹甘油三酯（mg/dl） x空腹血糖(mg/dl)/2]。缺血性脑卒中患病率为5.49%。在对所有协变量进行调整后，TyG每增加一个标准差，缺血性卒中的风险增加22.8%。当将TyG分成四分位数时，最高四分位数的缺血性中风风险是最低四分位数的1.776倍。此外，平滑曲线拟合表明，这种关联在整个TyG范围内是线性的。最后，将TyG引入临床危险因素后，AUC有所改善（0.746 vs 0.751, p = 0.029）。同样，无类别净再分类指数（0.195,95% CI: 0.112-0.277, P < 0.001）和综合区分指数（0.003,95% CI: 0.001-0.004, P < 0.001）证实TyG对缺血性卒中风险分层的改善。结论：预防缺血性脑卒中与TyG的增加成正比关系，提示TyG作为缺血性脑卒中的指标具有线性关系。我们的研究结果提示TyG在优化普通人群缺血性卒中风险分层方面的潜在价值。(C) 2019意大利糖尿病学会、意大利动脉粥样硬化研究学会、意大利人类营养学会和费德里科二世大学临床医学和外科学系。Elsevier B.V.版权所有。
Background and aims: Recent studies have recognized triglyceride-glucose index (TyG) as a practical surrogate of insulin resistance. Previous studies have demonstrated that insulin resistance contributes to ischemic stroke via multiple mechanisms. Our study aimed to investigate the association between TyG and prevalent ischemic stroke, exploring the value of TyG to optimize the risk stratification of ischemic stroke.Methods and results: This cross-sectional study included 10,900 subjects (mean age: 59.95 years, 59.8% females) from rural areas of northeast China between September 2017 to May 2018. TyG was calculated as ln[fasting triglyceride (mg/dl) x fasting plasma glucose (mg/dl)/2]. The prevalence of ischemic stroke was 5.49%. After adjusting for all covariates, each SD increment of TyG caused 22.8% additional risk for ischemic stroke. When dividing TyG into quartiles, the top quartile had a 1.776 times risk for ischemic stroke against the bottom category. Furthermore, smoothing curve fitting demonstrated this association was linear in the whole range of TyG. Finally, AUC revealed an improvement when introducing TyG into clinical risk factors (0.746 vs 0.751, p = 0.029). Consistently, category-free net reclassification index (0.195, 95% CI: 0.112-0.277, P < 0.001) and integrated discrimination index (0.003, 95% CI: 0.001-0.004, P < 0.001) confirmed the improvement by TyG to stratify ischemic stroke risk.Conclusion: The prevent ischemic stroke correlated proportionally with the increment of TyG, implicating the linearity of TyG as an indicator of ischemic stroke. Our findings suggest the potential value of TyG to optimize the risk stratification of ischemic stroke in a general population. (C) 2019 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.