实用医学杂志 ›› 2022, Vol. 38 ›› Issue (24): 3112-3124.doi: 10.3969/j.issn.1006⁃5725.2022.24.016

• 临床研究 • 上一篇    下一篇

胰岛素抵抗与Tyg指数与脑小血管病患者合并脑微出血的相关性 

孟启哲 奚志 王铭 王洋 杨霄鹏    

  1. 郑州大学第二附属医院神经内科(郑州 450003)

  • 出版日期:2022-12-25 发布日期:2022-12-25
  • 通讯作者: 杨霄鹏 E⁃mail:yaxipe39@126.com
  • 基金资助:
    河南省医学科技攻关计划项目(编号:SBGJ202102177)

Correlation between insulin resistance,Tyg index and cerebral microbleeds in patients with cerebral small vessel disease

MENG Qizhe,XI Zhi,WANG Ming,WANG Yang,YANG Xiaopeng.   

  1. Department of Neurology Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450003,China

  • Online:2022-12-25 Published:2022-12-25
  • Contact: YANG Xiaopeng E⁃mail:yaxipe39@126.com

摘要:

目的 探索胰岛素抵抗(insulin resistance,IR)、甘油三酯⁃葡萄糖(triglyceride⁃glucose,Tyg)相关指数与脑小血管病(cerebral small vessel disease,CSVD)患者发生脑微出血(cerebral microbleed,CMB)的 关系并建立预测模型。方法 选取 2021 1 月至 2022 5 月郑州大学第二附属医院收治的脑小血管病 患者 130 例作为临床研究对象,根据头颅磁敏感加权成像(susceptibility weighted imaging,SWI)上是否有微 出血病灶将其分为 CMB 组(42 例)和非 CMB 组(88 例)。记录患者临床基本资料并进行胰岛素抵抗(insu⁃ lin resistance,IR)相关指标[甘油三酯⁃葡萄糖指数(triglyceride⁃glucose,Tyg)、甘油三酯⁃葡萄糖⁃体脂指数 triglyceride⁃glucose⁃BMI,Tyg⁃BMI)]计算。采用多因素 logistic 回归分析探究 CSVD 患者并发 CMB 的影响 因素,并根据结果绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价其预测价值,构建列 线图预测模型。结果 CMB 组空腹血糖、高血压病史、Tyg、Tyg⁃BMI 均高于非 CMB 组(P < 0.05)。多因素 logistic 回归分析结果显示,空腹血糖(OR = 1.388,95%CI:1.101 ~ 1.752,P = 0.006)、高血压病史(OR = 2.683,95%CI:1.041 ~ 6.916,P = 0.041)、Tyg(OR = 5.808,95%CI:1.712 ~ 19.712,P = 0.005)、Tyg⁃BMI(OR = 1.034,95%CI:1.010 ~ 1.752,P = 0.006)升高是 CSVD 患者发生 CMB 的独立危险因素。基于 Tyg、Tyg⁃BMI CSVD 患者发生 CMB 的列线图预测模型。对预测模型进行内部校准,结果提示实际预测结果与理想 预测结果相近。并对该模型用决定曲线分析(decision curve analysis,DCA)做临床获益内部验证,结果提示该模型有较大临床获益。绘制 Tyg、Tyg⁃BMI 预测 CSVD 患者发生 CMB 风险的 ROC 曲线,结果显示,Tyg Tyg⁃BMI预测CSVD患者并发CMB风险的曲线下面积(area under the curves,AUC)分别是Tyg:0.700(95%CI 0.598 ~ 0.803,P < 0.01),Tyg⁃BMI:0.710(95%CI:0.618 ~ 0.802,P < 0.01)。结论 胰岛素抵抗与脑小血管病 患者并发脑微出血有关,胰岛素抵抗相关指标(Tyg、Tyg⁃BMI)对 CMB 的发生发展有一定的预测作用,通过 改善IR 对预防CMB 发生有一定的临床价值。

关键词:

脑小血管病; , 脑微出血; , 胰岛素抵抗; , Tyg , 指数; , 列线图

Abstract:

Objective To explore the relationship between insulin resistance(IR),triglyceride ⁃glucose (Tyg)correlation index and cerebral microbleed(CMB)in patients with cerebral small vessel disease(CSVD),and to establish a predictive model. Methods A total of 130 patients with cerebral small vessel disease who were admitted to the Second Affiliated Hospital of Zhengzhou University from January 2021 to May 2022 were selected as clinical research subjects,and they were divided into CMB group(42 cases)and Non⁃CMB group(88 cases). The basic clinical data of the patients were recorded and the IR ⁃ related indicators[triglyceride ⁃ glucose index (Tyg),triglyceride⁃glucose⁃BMI index(Tyg⁃BMI)]were recorded. Multivariate Logistic regression analysis was used to explore the influencing factors of CMB in patients with cerebral small vessel disease,and according to the results,a receiver operating characteristic(ROC)curve was drawn to evaluate its predictive value,and a nomogram prediction model was constructed. Results Fasting blood glucose,history of hypertension,Tyg and Tyg ⁃BMI in the CMB group were higher than those in the non⁃CMB group(P < 0.05). Multivariate Logistic regression analysis showed that fasting blood glucose(OR = 1.388,95%CI:1.101 ~ 1.752,P = 0.006),history of hypertension(OR = 2.683,95%CI:1.041 ~ 6.916,P = 0.041),Tyg(OR = 5.808,95%CI:1.712 ~ 19.712,P = 0.005),Tyg⁃ BMI(OR = 1.034,95%CI:1.010 ~ 1.752,P=0.006)elevated were risk factors for developing CMB in patients with CSVD. A nomogram prediction model of CMB in patients with cerebral small vessel disease was established based on Tyg and Tyg⁃BMI. DCA was used for internal verification of clinical benefit,and the results suggest that the model had clinical benefit. The ROC curves of Tyg and Tyg⁃BMI for predicting the risk of CMB in patients with cerebral small vessel disease were drawn. The results showed that the area under the curve(AUC)of Tyg and Tyg⁃ BMI for predicting the risk of CMB in patients with cerebral small vessel disease were Tyg:0.700 respectively (95%CI:0.598 ~ 0.803,P < 0.01),Tyg⁃BMI:0.710(95%CI:0.618 ~ 0.802),P < 0.01). Conclusions Insulin resistance may affect the risk of CMB in patients with cerebral small vessel disease. Insulin resistance⁃related indi⁃ cators(Tyg,Tyg⁃BMI)can have a certain predictive effect on the occurrence of CMB. Improving IR has a certain clinical value in preventing the occurrence of CMB.

Key words:

cerebral small vessel disease, cerebral microbleeds, insulin resistance, tyg index, nomogram