2022 年第 1 期 第 17 卷

三酰甘油葡萄糖乘积指数对短暂性脑缺血发作患者近期脑卒中风险的预测价值

Predictive value of triglyceride-glucose index in the risk of recent stroke in patients with transient ischemic attack

作者：谢翼1曹亚军1姬燕1高修银2李雷3

英文作者：Xie Yi1 Cao Yajun1 Ji Yan1 Gao Xiuyin2 Li Lei3

单位：1徐州医科大学研究生学院，江苏省徐州市221004；2徐州医科大学公共卫生学院，江苏省徐州市221004；3徐州医科大学附属医院全科医学科，江苏省徐州市221006

英文单位：1Graduate School of Xuzhou Medical University Jiangsu Province Xuzhou 221004 China; 2School of Public Health Xuzhou Medical University Jiangsu Province Xuzhou 221004 China; 3Department of General Medicine the Affiliated Hospital of Xuzhou Medical University Jiangsu Province Xuzhou 221006 China

关键词：短暂性脑缺血发作；缺血性脑卒中；三酰甘油葡萄糖乘积指数；ABCD3-Ⅰ评分

英文关键词：Transientischemicattack;Ischemicstroke;Triglyceride-glucoseindex；ABCD3-Ⅰscore

• 摘要：

• 目的 探讨三酰甘油葡萄糖乘积（TyG）指数对短暂性脑缺血发作(TIA)患者90 d内发生缺血性脑卒中的预测价值。方法 选取2019年7月至2020年6月于徐州医科大学附属医院神经内科住院治疗的307例TIA患者（TIA组），以及同期本院体检中心健康体检者307例（对照组）作为研究对象。TIA患者根据发病后90 d内是否发生缺血性脑卒中分为脑卒中组（34例）和非脑卒中组（273例）。比较各组的临床资料。分析TyG指数和ABCD3-Ⅰ评分的相关性。Logistic回归分析筛选TIA患者90 d内发生缺血性脑卒中的危险因素。绘制受试者工作特征（ROC）曲线分析TyG指数与ABCD3-Ⅰ评分单独或联合预测TIA患者近期缺血性脑卒中的价值。结果 TIA组TyG指数高于对照组［8.67(8.29,9.11)比8.49(8.13,8.84)］，脑卒中组ABCD3-Ⅰ评分、TyG指数均高于非脑卒中组［8(6,11)分比3(2,6)分、（9.6±0.8）比（8.6±0.6）］（均P＜0.05）。Spearman相关性分析显示TyG指数与ABCD3-Ⅰ评分呈正相关（r=0.825，P＜0.001）。多因素Logistic回归分析结果显示，ABCD3-Ⅰ评分（比值比=1.262，95%置信区间：1.013～1.574，P=0.038）、TyG指数（比值比=3.607，95%置信区间：1.304～9.979，P=0.013）是TIA患者90 d内发生缺血性脑卒中的独立危险因素。ROC曲线结果显示TyG指数、ABCD3-Ⅰ评分单独预测TIA患者近期缺血性脑卒中的曲线下面积（AUC）分别为0.866（95%置信区间：0.814～0.918）、0.846（95%置信区间：0.773～0.919），敏感度分别为94.1%、70.6%，特异度分别为65.8%、87.9%。二者联合预测的AUC为0.873（95%置信区间：0.817～0.928），敏感度为79.4%，特异度为81.7%。结论  TyG指数和ABCD3-Ⅰ评分是TIA患者90 d内缺血性脑卒中的独立预测因子，二者呈正相关。TyG指数联合ABCD3-Ⅰ评分可以提高对TIA患者90 d内缺血性脑卒中的预测价值。

• Objective   To investigate the predictive value of triglyceride-glucose (TyG) index in the risk of ischemic stroke within 90 d in patients with transient ischemic attack (TIA).Methods  From July 2019 to June 2020, 307 TIA inpatients (TIA group) admitted to Department of Neurology, the Affiliated Hospital of Xuzhou Medical University and 307 healthy subjects (control group) in the physical examination center of the hospital during the same period were selected. Patients with TIA were divided into stroke group (34 cases) and non-stroke group (273 cases) according to whether ischemic stroke occurred after the onset of TIA. The clinical data were compared among the groups. The correlation between TyG index and ABCD3-Ⅰ score was analyzed. Logistic regression analysis was used to screen risk factors for ischemic stroke within 90 d in patients with TIA. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of TyG index and ABCD3-Ⅰ score in recent ischemic stroke in paitents with TIA separately and in combination.Results  TyG index in TIA group was higher than that in control group［8.67(8.29,9.11) vs 8.49(8.13,8.84)］, ABCD3-Ⅰ score and TyG index in stroke group were higher than those in non-stroke group［8(6,11) vs 3(2,6),（9.6±0.8） vs （8.6±0.6）］(all P＜0.05). Spearman correlation analysis showed that TyG index was positively correlated with ABCD3-Ⅰ score (r=0.825, P＜0.001). Multivariate Logistic regression analysis showed that ABCD3-Ⅰ score (odds ratio=1.262, 95% confidence interval: 1.013-1.574, P=0.038) and TyG index (odds ratio=3.607, 95% confidence interval: 1.304-9.979, P=0.013) were independent risk factors of ischemic stroke in paitents with TIA within 90 d. The ROC curve showed that the area under the curve (AUC) of TyG index and ABCD3-Ⅰ score in separately predicting recent ischemic stroke in paitents with TIA was 0.866 (95% confidence interval: 0.814-0.918) and 0.846 (95% confidence interval: 0.773-0.919), sensitivity was 94.1% and 70.6%, and specificity was 65.8% and 87.9%, respectively. The AUC of the two parameters comdination was 0.873 (95% confidence interval: 0.817-0.928), sensitivity was 79.4%, and specificity was 81.7%. Conclusions  TyG index and ABCD3-Ⅰ score were independent predictors of ischemic stroke within 90 d in patients with TIA, and there was a positive correlation between them. The combination of TyG index and ABCD3-Ⅰ score can improve the predictive value in ischemic stroke within 90 d in patients with TIA.