Objectives

to investigate the relationship between insulin resistance (IR) and clinical outcomes in non-diabetic ischemic stroke patients treated with intravenous thrombolysis.

Methods

We recruited non-diabetic ischemic stroke patients treated with intravenous thrombolysis prospectively. IR was defined as homeostasis model assessment–estimated insulin resistance index ≥2.80. Initial stroke severity was assessed using the National Institutes of Health Stroke Scale scores, and infarct volume was measured using DWI. Clinical outcomes were evaluated by neurological improvement and hemorrhagic transformation at 24 hours, and favorable functional prognosis at 90 days.

Results

232 patients were enrolled into this study. IR group was 67 patients, non-IR group was 165 patients. Compared with the non-IR group, the probability of neurological improvement at 24 h ours and favorable functional outcome at 90 days in IR group were all significantly lower (41.79% vs 63.03%, p<0.01; 73.13% vs 89.09%, p<0.01 respectively), whereas the ratio of hemorrhagic transformation was much higher (16.42% vs 4.85%, p<0.01). In multivariable logistic regression, IR was negatively associated with neurological improvement and favorable functional prognosis (OR=0.39, 95%CI, 0.20–0.76, p<0.01; OR= 0.26, 95%CI, 0.07–0.91, p=0.04, respectively), but was positively correlated with hemorrhagic transformation (OR=4.07, 95%CI, 1.13–14.59, p=0.03) after adjusting traditional risk factors. We analyzed 108 infarct volume data further, the median of volume in IR group was 2.27 cm³, higher than that in non-IR group (1.96 cm³), but no statistical difference (p=0.65).

Conclusions

In non-diabetic ischemic stroke patients treated with intravenous thrombolysis, IR was related with worse clinical outcomes, but not with infarct volume.

中文翻译：

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在静脉溶栓治疗的非糖尿病急性缺血性卒中患者中，胰岛素抵抗与不良的临床结果显着相关

目标

研究非糖尿病性缺血性中风患者经静脉溶栓治疗后胰岛素抵抗（IR）与临床结局之间的关系。

方法

我们招募了接受静脉溶栓治疗的非糖尿病性缺血性中风患者。IR被定义为体内稳态模型评估-胰岛素抵抗指数≥2.80。使用美国国立卫生研究院卒中量表评分评估初始卒中严重程度，并使用DWI测量梗死面积。通过24小时的神经功能改善和出血转化以及90天的良好功能预后来评估临床结局。

结果

232名患者参加了本研究。IR组为67例，非IR组为165例。与非IR组相比，IR组在24 h时神经功能改善和90天后功能良好的可能性均显着降低（41.79％vs 63.03％，p <0.01； 73.13％vs 89.09％，p < 0.01），而出血转化的比例要高得多（16.42％对4.85％，p <0.01）。在多变量logistic回归中，IR与神经功能改善和功能预后良好呈负相关（OR = 0.39，95％CI，0.20-0.76，p <0.01； OR = 0.26，95％CI，0.07-0.91，p分别调整为0.04），但在调整传统危险因素后与出血性转化呈正相关（OR = 4.07、95％CI，1.13-14.59，p = 0.03）。我们进一步分析了108个梗塞体积数据，IR组的体积中位数为2.27 cm ³，高于非IR组（1.96 cm ³），但无统计学差异（p = 0.65）。

结论

在接受静脉溶栓治疗的非糖尿病性缺血性中风患者中，IR与临床效果较差相关，但与梗死面积无关。