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    三酰甘油—葡萄糖指数评估急性脑梗死阿替普酶静脉溶栓病人临床预后的研究

    Study on the application value of triglyceride-glucose index in assessing the clinical prognosis of acute ischemic stroke patients treated with alteplase intravenous thrombolysis

      摘要
    • 摘要:
      目的： 探讨三酰甘油—葡萄糖指数（TyG）评估阿替普酶（rt-PA）静脉溶栓的急性脑梗死（AIS）病人预后的临床应用。
      方法： 收集接受rt-PA静脉溶栓治疗AIS病人122例。根据随访3个月后的改良Rankin量表（mRS）评分，将病人分为预后良好组（mRS ≤ 2分）70例和预后不良组（mRS ＞ 2分）52例；根据随访3个月生存状态，将病人分为生存组107例与死亡组15例。采用ROC曲线评估TyG预测病人预后的准确性和特异性，依据最佳截断值将病人分为高TyG组59例和低TyG组63例，分析TyG与病人临床预后的关系；采用限制性立方样条（RCS）曲线判断TyG与mRS评分的变化趋势。
      结果： 预后良好组病人TyG明显低于预后不良组（P ＜ 0.01）；死亡组TyG明显高于生存组病人（P ＜ 0.01）。多因素logistic回归分析显示，TyG是静脉溶栓AIS病人预后不良和脑卒中相关死亡的独立影响因素（P ＜ 0.01）。ROC曲线分析显示，TyG预测静脉溶栓AIS病人3个月后不良临床预后的AUC为0.750，最佳截断值为7.325，灵敏度为73.1%，特异度为70.1%。高TyG组病人3个月后不良预后发生率和死亡率均明显高于低TyG组（P ＜ 0.01）。RCS曲线显示，TyG与mRS评分呈非线性关系，TyG ＜ 7.325时，随着TyG增高，病人预后不良风险缓慢升高；TyG ＞ 7.325时，随着TyG升高，病人预后不良风险快速升高。
      结论： 高水平TyG与接受rt-PA静脉溶栓治疗的AIS病人的不良预后相关。

       

      Abstract:
      Objective To explore the application value of triglyceride-glucose index (TyG) in assessing the prognosis of acute ischemic stroke (AIS) patients treated with alteplase (rt-PA) intravenous thrombolysis.
      Methods A total of 122 AIS patients treated with rt-PA intravenous thrombolysis were collected. According to the modified Rankin scale (mRS) score after 3 months of follow-up, the patients were divided into the good prognosis group (70 cases, mRS ≤ 2 points) and poor prognosis group (52 cases, mRS ＞ 2 points). According to the 3-month follow-up, the patients were divided into the survival group (107 cases) and death group (15 cases). ROC curve was used to evaluate the accuracy and specificity of TyG in predicting the prognosis of patients. The patients were divided into the high TyG group (59 cases) and low TyG group (63 cases) according to the best truncation value, and the relationship between TyG and clinical prognosis of patients was analyzed. The restricted cubic spline (RCS) curve was used to determine the variation trend of TyG and mRS score.
      Results The TyG in the good prognosis group was significantly lower than that in poor prognosis group (P ＜ 0.01). The TyG in the death group was significantly higher than that in survival group (P ＜ 0.01). The results of multivariate logistic regression analysis showed that TyG was the independent influencing factor of poor prognosis and stroke-related death in AIS patients treated with intravenous thrombolysis (P ＜ 0.01). The results of ROC curve analysis showed that the AUC, optimal cut-off value, sensitivity and specificity of TyG in predicting the poor clinical prognosis of AIS patients treated with intravenous thrombolysis for 3 months were 0.750, 7.325, 73.1% and 70.1%, respectively. The incidence of adverse prognosis and mortality in the high TyG group after 3 months were significantly higher than those in low TyG group (P ＜ 0.01). The results of RCS curve showed that there was a nonlinear relationship between TyG and mRS score. When TyG ＜ 7.325, the risk of poor prognosis slowly increased with the increase of TyG. When TyG ＞ 7.325, the risk of poor prognosis rapidly increased with the increase of TyG.
      Conclusions High level of TyG is associated with the poor prognosis of AIS patients treated with rt-PA intravenous thrombolysis.

       

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