C反应蛋白-甘油三酯葡萄糖指数在预测急性缺血性卒中不良预后中的预后作用：一项大规模队列研究

摘要(中文译文)

C反应蛋白-甘油三酯葡萄糖指数（CTI）已被确立为一种反映胰岛素抵抗和全身性炎症的新型生物标志物。然而，其与急性缺血性卒中（AIS）不良结局的关联，尤其是在按血糖状态对患者进行分层时，仍不明确。本研究共纳入2010年至2016年间首尔国立大学医院收治的1485例AIS患者。主要结局为不良预后，定义为3个月时改良Rankin量表评分≥3分。CTI通过以下公式计算：0.412×ln（hs-CRP[mg/L]）+ln（TG[mg/dL]×FBG[mg/dL]）/2。采用logistic回归模型和限制性立方样条分析评估CTI与卒中不良结局之间的关联，并按性别和血糖状态进行分层。此外还进行了亚组分析和倾向性评分分析以验证研究结果的稳健性。AIS发病后3个月时，414例患者（27.88%）出现不良结局。我们的研究结果揭示了CTI水平与AIS患者不良结局风险之间存在显著的正向线性关联。该关联在男女两性中均显著，男性中观察到的比值比（OR 1.591，95%CI：1.235-2.050）高于女性（OR 1.347，95%CI：1.004-1.807）。按血糖状态对个体进行分层后，CTI升高与糖尿病前期（pre-DM）个体（OR 1.634，95%CI：1.267-2.108）和糖尿病（DM）个体（OR 1.819，95%CI：1.315-2.517）不良结局风险增加显著相关，而在血糖调节正常的参与者中未观察到具有统计学意义的关联。CTI水平升高与AIS患者不良结局风险增加显著相关，且在男性中关联更强。该关系在糖尿病前期和糖尿病患者中仍然显著，但在血糖调节正常者中不明显。这些发现提示，CTI或可作为识别AIS不良预后高风险患者的一种简便有效的生物标志物。

Abstract

The C-reactive protein-triglyceride glucose index (CTI) has been established as a novel biomarker reflecting insulin resistance and systemic inflammation. However, its association with unfavorable outcomes in acute ischemic stroke (AIS), especially when patients are stratified by glycemic status, remains unclear. A total of 1485 patients with AIS admitted to Seoul National University Hospital between 2010 and 2016 were included in this study. The primary outcome was poor prognosis, defined as a modified Rankin scale score ≥3 at 3 months. The CTI was calculated via the following formula: 0.412 × ln (hs-CRP [mg/L]) + ln (TG [mg/dL] × FBG [mg/dL])/2. Logistic regression models and restricted cubic spline analyses were used to evaluate the associations between the CTI and poor stroke outcomes, with stratification by sex and glycemic status. Subgroup analyses and propensity score analyses were also conducted to validate the robustness of the findings. At 3 months after AIS onset, 414 patients (27.88%) experienced poor outcomes. Our findings revealed a significant positive linear association between CTI levels and the risk of unfavorable outcomes in AIS patients. The association was significant in both sexes, with a higher odds ratio observed in males (OR 1.591, 95% CI: 1.235-2.050) than in females (OR 1.347, 95% CI: 1.004-1.807). When individuals were stratified by glycemic status, an elevated CTI was significantly associated with an increased risk of poor outcomes among individuals with prediabetes (pre-DM) (OR 1.634, 95% CI: 1.267-2.108) and diabetes mellitus (DM) (OR 1.819, 95% CI: 1.315-2.517), whereas no statistically significant association was observed in participants with normal glucose regulation. Elevated CTI levels were significantly associated with an increased risk of unfavorable outcomes in AIS patients, with a stronger association observed in males. This relationship remained significant among individuals with prediabetes and diabetes but was not evident in those with normal glucose regulation. These findings suggest that the CTI may serve as a simple and effective biomarker for identifying AIS patients at greater risk of poor prognosis.

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