国家神经系统疾病临床医学研究中心数据管理与共享系统

Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

《国家中心数据管理与共享系统操作说明书 —— 研究者部分》

Mediation of Systemic Inflammation on Insulin Resistance and Prognosis of Nondiabetic Patients With Ischemic Stroke

第一作者：Aoming Jin, Shukun Wang

通讯作者：Yuesong Pan

C-reactive protein; insulin resistance; ischemic stroke; mediation analysis; prognosis

基本信息

2023-01-03

已发表文章

发表杂志：Stroke

发表类型: Original Contributions

影响因子(IF): 8.3

PMID: 36722344 Pubmed原文链接 全文下载

主要研究背景及目的

Abnormal glucose metabolism is one of the most important therapeutic targets for precise treatment of cardio-/cerebrovascular diseases, and insulin resistance is an important pathological process in the occurrent and development of abnormal glucose metabolism. However, it is still unclear about the relationship between insulin resistance and clinical prognosis of ischemic stroke and its subtypes, and few study analyzed based on genetic polymorphism. Therefore, we hypothesized that insulin resistance has a predictive value in the prognosis of ischemic stroke and its subtypes. In this study, we will estimate the association between insulin resistance and outcome of ischemic stroke and its subtypes. This study will provide a new clue to elucidate the association of abnormal glucose metabolism with stroke outcome.

方法

METHODS: Patients with ischemic stroke but without a history of diabetes who were enrolled in CNSR-III (Third China National Stroke Registry) were included in the study and followed up for 1 year after stroke onset. Insulin resistance was determined by using the homeostasis model assessment for insulin resistance (HOMA-IR) method. hs-CRP (high-sensitivity C-reactive protein) and Lp-PLA2 (lipoprotein-associated phospholipase A2) activity were measured at baseline. The primary outcome was stroke recurrence, and other outcomes included composite vascular events, mortality, and poor functional outcome (modified Rankin Scale score, 3–6). Multivariable Cox or logistic regression analyses were performed to estimate the association between HOMA-IR and the study outcomes. A mediation analysis was performed to examine the relationship between insulin resistance and the study outcomes mediated by systemic inflammation.

结论

CONCLUSIONS: Our study found that insulin resistance was associated with poor clinical outcomes in nondiabetic patients with ischemic stroke, which was partially mediated by hs-CRP with a modest amount.

主要结果

RESULTS: Among a total of 3808 nondiabetic patients with ischemic stroke who were included in the study, the median HOMA-IR was 1.79 (interquartile range, 1.05–2.97). After adjustments for potential confounders, higher HOMA-IR quartiles were associated with higher risks of stroke recurrence, ischemic stroke, and composite vascular events, especially in the large artery atherosclerosis subtype. hs-CRP partially mediated the association between the HOMA-IR index and the prognosis of ischemic stroke (mediation proportion, 5.9% for stroke recurrence and 7.5% for composite vascular events). No evidence of Lp-PLA2 activity mediating the association of insulin resistance with stroke outcomes was observed.