Page 36 - 2022-26-中国全科医学

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BAI Xue ，CHEN Pan ，WAN Qin 1*
1.Department of Endocrinology，the Affiliated Hospital of Southwest Medical University，Luzhou 646000，China
2.Department of Cardiology，Luzhou People's Hospital，Luzhou 646000，China
*
Corresponding author：WAN Qin，Chief physician；E-mail：wanqin3@126.com
【Abstract】 Background In recent decades，ischemic stroke is increasingly prevalent，which has become the second
leading cause of death and disability in the world. Insulin resistance and obesity are closely related to the development of ischemic
stroke. At present，a number of studies have confirmed that obesity is associated with a variety of metabolic diseases and the role
of insulin resistance played in the pathogenesis. But it is still unclear whether TyG，an indicator of insulin resistance，and TyG
combined with obesity indicators can be used to predict ischemic stroke. Objective To assess the influencing factors of TyG，
and its combination with different obesity indicators for new-onset ischemic stroke in a cohort of middle-aged and elderly people
during a 10-year follow-up . Methods A prospective cohort design was used. The cohort included 9 406 middle-aged and elderly
individuals who attended the 2011 Epidemiological Survey on Cancer Risk in Type 2 Diabetics conducted in six communities in
Luzhou （including Qiancao，Xiaoshi，Longmatan，Baolaiqiao，Dashanping and Yutang） . Baseline data were collected，
including TyG and its combination with different obesity indicators〔TyG-waist circumference （WC），TyG-waist-to-height-
ratio （WHtR），TyG-body mass index （BMI），and TyG-waist-to-hip-ratio （WHR）〕. A 5-year follow-up initiated
since June to November 2016，and a 10-year follow-up initiated since April to June 2021 were conducted，with new-onset
ischemic stroke incidence （obtained through Luzhou Health Commission and Luzhou Center for Disease Control & Prevention）
as an endpoint. For assessing the predictive value of baseline TyG，TyG-WC，TyG-WHtR，TyG-BMI，and TyG-WHR for
new-onset ischemic stroke，patients were divided into quartiles of TyG〔Q1（n=2 351），Q2（n=2 351），Q3（n=2 352），
Q4（n=2 352）〕，quartiles of TyG-WC〔Q1（n=2 351），Q2（n=2 352），Q3（n=2 352），Q4（n=2 351）〕，
quartiles of TyG-WHtR〔Q1（n=2 349），Q2（n=2 349），Q3（n=2 348），Q4（n=2 348）〕，and quartiles of TyG-BMI
〔Q1（n=2 351），Q2（n=2 352），Q3（n=2 352），Q4（n=2 351）〕，quartiles of TyG-WHR〔Q1（n=2 343），Q2
（n=2 343），Q3（n=2 342），Q4（n=2 342）〕，respectively. Multivariate Logistic regression analysis was used to explore
the relationship between TyG，TYG-WC，TYG-WTHR，TYG-BMI，TYG-WHR and new ischemic stroke in the elderly.
Results During the follow-up period，527（5.6%） of the 9 406 middle-aged and elderly people had new-onset ischemic
stroke. After adjusting for multiple confounding variables，multivariate Logistic regression analysis showed that the risk of new
ischemic stroke in the fourth quartile group of TyG was 1.569 times higher than that in the first quartile group of TyG〔OR=1.569，
95%CI（1.007，2.437），P=0.046〕. The risk of new ischemic stroke increased by a factor of 1.467，2.012，and 2.132 in the
second，third and fourth quartile groups of TyG-WC〔 OR=1.467，95%CI（1.010，2.131），P=0.044；OR=2.012，95%CI（1.270，
3.187），P=0.003；OR=2.132，95%CI（1.119，4.063），P=0.021〕compared with that in the first quartile group of TyG-
WC. The risk of new ischemic stroke increased by a factor of 1.481，1.548，and 1.705 in the second，third and fourth quartile
groups of TyG-BMI 〔OR=1.481，95%CI（1.071，2.048），P=0.018；OR=1.548，95%CI（1.066，2.247），P=0.022；
OR=1.705，95%CI（1.054，2.759），P=0.030〕compared with that in the first quartile group of TyG-BMI. Conclusion The
risk of new-onset ischemic stroke in middle-aged and elderly type 2 diabetics in Luzhou increased with the elevation of TyG-WC
and TyG-BMI，so TyG-WC and TyG-BMI may be predictors of new-onset ischemic stroke in this population.
【Key words】 Stroke；Triglyceride-glucose index；Insulin resistance；Obesity；Middle aged；Aged；Cohort
studies；Prospective studies；Root cause analysis

近几十年来，缺血性脑卒中的患病率逐年上升，已 生中起着重要作用 ［6-7］ 。既往研究发现高胰岛素血症 - 正
成为全球死亡及致残的第 2 大原因 ［1-2］ 。在我国，随 葡萄糖钳夹技术是评价 IR 的金标准，然而，这项技术
着社会老龄化和城市化进程的加速，居民不健康生活方 由于技术复杂、成本高以及伦理等问题，在临床中难
式的流行，缺血性脑卒中的发病率及病死率也不断上 以实施 ［8］ 。近年来，有学者提出甘油三酯葡萄糖指数
升，成为致死的第一大主因 ［3-4］ 。目前，中国 40~74 岁 （triglyceride glucose index，TyG）是反映 IR 的重要指标，
居民首次脑卒中标化发病率平均每年增长 8.3%；年龄 与 IR 的稳态模型评估（HOMA-IR）和高胰岛素血症 - 正
≥ 40 岁居民脑卒中标化患病率由 2012 年的 1.89% 上升 葡萄糖钳夹技术密切相关 ［9-11］ 。因此，本研究通过队
至 2018 年的 2.32%，推算年龄≥ 40 岁居民脑卒中现患 列研究分析 TyG 及其结合不同肥胖指标是否为泸州地
人数 1 318 万，每年 190 余万人因脑卒中死亡 ［3］ 。 区 40 岁以上中老年人 10 年新发缺血性脑卒中的影响因
肥胖是缺血性脑卒中的主要危险因素，并常与之并 素，以期减少中老年人群脑卒中发生率，为中老年人群
存 ［5］ 。胰岛素抵抗（IR）在缺血性脑卒中及肥胖的发 个体分层管理提供理论依据。