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

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Insulin Resistance Index from OGTT Predicts Ischemic Stroke Outcomes in Non-Diabetic Patients with Different eGFR Strata

第一作者：Yilun Zhou,Zhang Yin,Yuesong Pan

通讯作者：Yongjun Wang

Insulin resistance Ischemic stroke Outcome Renal f

基本信息

2018-03-15

已发表文章

发表杂志：Cerebrovasc Dis

发表类型: Original Contributions

影响因子(IF): 2.762

PMID: 30235440 Pubmed原文链接 全文下载

主要研究背景及目的

Insulin resistance is associated with cardiovascular morbidity and mortality in the general population. However, the relationship between insulin resistance and health outcomes is controversial in patients with impaired renal function. Our study aimed to investigate the association between insulin resistance and prognosis in a cohort of nondiabetic stroke patients with different estimated glomerular filtration rate (eGFR) strata.

方法

Data were derived from Abnormal Glucose Regulation in Patients with Acute Stroke across China (ACROSS-China) registry. Ischemic stroke patients without history of diabetes were included. Fasting and oral glucose tolerance test (OGTT)-derived measures of insulin resistance were calculated along with homeostasis model assessment of insulin resistance (HOMA-IR) and composite insulin sensitivity index (ISI). Insulin resistance was defined by the highest HOMA-IR quartile (Q4) and the lowest composite ISI quartile (Q1).

结论

An OGTT-derived estimate of insulin resistance with the composite ISI, but not HOMA-IR, was independently associated with increased risks of 1-year mortality and poor functional outcome in non-diabetic ischemic stroke patients with different eGFR strata.

主要结果

Among 1,196 patients, HOMA-IR Q4 (insulin resistance) vs. Q1–3 was associated with increased 1-year mortality (adjusted hazards ratio [HR] 1.83, 95% CI 1.07–3.13) and poor functional outcome (adjusted OR 1.97, 95% CI 1.32–2.95) only in participants with an eGFR ≥90 mL/min/1.73 m2. By comparison, composite ISI Q1 (insulin resistance) vs. Q2–4 was associated with higher risks of 1-year mortality (adjusted HR 3.64, 0.90–14.78; 2.50, 1.19–5.26; and 1.99, 1.17–3.39, respectively) and poor functional outcome (adjusted OR 3.62, 1.08–12.19; 1.51, 0.85–2.70; and 2.25, 1.42–3.57, respectively) in all 3 subgroups with eGFR < 60, 60–89, and ≥90 mL/min/1.73 m2.