Preoperative Fasting Triglyceride-glucose Index as a Predictor of Contralateral New Silent Ischemic Brain Lesions after Carotid Artery Stenting
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摘要:
目的 探讨术前空腹甘油三酯-血糖指数（triglyceride-glucose index，TyG）对颈内动脉支架置入术（carotid artery stenting，CAS）后对侧新发无症状缺血性脑损伤（contralateral new silence ischemic brain lesions，CNSIBL）的预测价值。 方法 回顾性分析行颈内动脉支架置入术患者183例，根据是否存在CNSIBL发生的情况分为CNSIBL组50例和non- CNSIBL组133例，收集患者基线资料、实验室检查及影像学检查指标，计算TyG。以是否发生CNSIBL为因变量，控制混杂因素后，以TyG为自变量进行多因素Logistic回归分析和受试者工作特征曲线评价TyG对CAS后CNSIBL的预测价值。 结果 （1）CNSIBL组患者糖尿病病史例数、入院时收缩压及舒张压高于non-CNSIBL组（P < 0.05）；（2）CNSIBL组甘油三酯高于non-CNSIBL组（P < 0.05）；CNSIBL组TyG高于non-CNSIBL组（P < 0.05）；（3）多因素Logistic回归分析结果提示TyG [矫正OR = 1.125，95% CI （1.042−1.214），P < 0.001]是颈内动脉支架置入术后对侧新发无症状缺血性脑损伤的独立影响因素；（4）ROC曲线提示，TyG预测颈内动脉支架置入术后对侧新发无症状缺血性脑损伤的AUC为0.77[95%CI （0.71−0.84），P < 0.001]，cut-off值为1.93，灵敏度86.0%，特异度63.9%。 结论 TyG是颈内动脉支架置入术后对侧新发无症状缺血性脑损伤的独立影响因素。 -
关键词:
- 颈内动脉支架置入术 /
- 对侧新发无症状缺血性脑损伤 /
- 甘油三酯-血糖指数 /
- 动脉粥样硬化
Abstract:Objective To investigate the predictive value of the preoperative fastingTriglyceride-Glucose index （TyG） for contralateral new silence ischemic brain lesions （CNSIBL） following carotid artery stenting （CAS）. Methods A retrospective study was conducted to analyze the clinical data of 183 patients who underwent carotid CAS. The patients were divided into a CNSIBL group （50 cases） and a non-CNSIBL group （133 cases） based on the occurrence of CNSIBL. Baseline data, laboratory tests, and imaging indicators were collected, and TyG was calculated. Using the occurrence of CNSIBL as the dependent variable, multivariate logistic regression analysis was performed with TyG as the independent variable after controlling for confounding factors, and the predictive value of TyG for CNSIBL post-CAS was evaluated using receiver operating characteristic （ROC） curves. Results （1）The number of patients with a history of diabetes mellitus, as well as systolic and diastolic blood pressure on admission in CNSIBL group were statistically significantly higher than that in non-CNSIBL group（P < 0.05）.（2） Triglyceride （TC） levels were higher in the CNSIBL group compared to the non-CNSIBL group（P < 0.05）; TyG was also higher in the CNSIBL group than in the non-CNSIBL group （P < 0.05）; （3） Multivariate Logistic regression analysis results showed that TyG [a OR = 1.125, 95% CI （1.042−1.214）, P < 0.001]was an independent risk factor for contralateral new silent ischemic brain lesions after carotid artery stenting;（4） The ROC curve suggested that the AUC for TyG predicting contralateral new silent ischemic brain lesions post-CAS was 0.77 [95% CI （0.71−0.84）, P < 0.001], with a cut-off value of 1.93, sensitivity of 86.0%, and specificity of 63.9%. Conclusion TyG is an independent influencing factor for contralateral new silent ischemic brain lesions following carotid artery stenting. -
图 1 67岁男性右侧颈内动脉起始段重度狭窄行颈动脉起始段支架置入术
A：为术前头MRI-DWI，无脑梗死病灶；B：数字减影血管造影，右侧颈内动脉起始段重度狭窄（蓝色箭头所示）；C：数字减影血管造影，右侧颈内动脉起始段支架置入术后（蓝色箭头所示）；E、术后头MRI-DWI，左侧颞叶新发DWI高信号（橘色箭头所示）；F：术后头MRI-DWI，左侧半卵圆中心新发DWI高信号（橘色箭头所示）。
Figure 1. A 67-year-old male with severe stenosis in the right internal carotid artery origin （C1） undergoing stenting of the carotid artery origin
图 2 TyG预测颈内动脉支架置入术后对侧新发无症状缺血性脑损伤的ROC曲线
Figure 2. ROC curve of TyG predicting contralateral new silent ischemic brain lesions after carotid artery stenting
表 1 行颈内动脉支架置入术患者基线资料和实验室检查数据[$ \bar x \pm s $/M（P25，P75）/n（%）]
Table 1. Baseline data and laboratory test results of patients undergoing carotid artery stenting [$ \bar x \pm s $/M（P25，P75）/n（%）]
基线信息 non-CNSIBL组
n = 133CNSIBL组
n = 50t/χ2/z P 年龄（岁） 65.9 ± 12.7 67.7 ± 13.6 0.683 0.495 男性 99（74.4） 38（76.0） 0.047 0.828 高血压病史 95（71.4） 37（74.0） 0.120 0.730 糖尿病病史 62（46.6） 32（64.0） 4.396 0.036* 高脂血症病史 60（45.1） 22（44.0） 0.018 0.893 缺血性脑卒中病史 25（18.8） 11（22.0） 0.236 0.627 吸烟史 58（43.6） 18（36.0） 0.866 0.352 饮酒史 61（45.9） 24（48.0） 0.067 0.796 冠状动脉粥样硬化性心脏病病史 22（16.5） 12（24.0） 1.336 0.248 入院时收缩压（mmHg） 137.9 ± 23.1 146.8 ± 22.2 5.094 0.031* 入院时舒张压（mmHg） 85.4 ± 15.3 88.6 ± 16.4 3.741 0.049* 入院时NIHSS评分 4[2，7] 4[2，8] 0.496 0.506 静脉rt-PA治疗 27（20.3） 10（20.0） 0.002 0.964 颈内动脉颅内段 78（58.6） 32（64.0） 0.434 0.510 右侧颈内动脉 65（48.9） 23（46.0） 0.120 0.729 开环支架 87（65.4） 34（68.0） 0.109 0.742 空腹血糖（mmol/L） 4.94[4.29−8.11] 6.81[5.29−9.01] 3.734 0.068 甘油三酯 （mmol/L） 1.20[0.57−2.21] 1.94[1.14−3.06] 8.864 0.004* TyG 1.11[0.36−2.23] 1.87[1.06−2.44] 12.241 0.001* 缩写：CAS，颈内动脉支架置入术； CNSIBL，对侧新发无症状缺血性脑损伤；NIHSS：美国国立卫生研究院卒中量表； rt-PA：重组组织型纤溶酶原激活剂；TyG，甘油三酯-血糖指数*P < 0.05具有统计学差异。 
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