胰岛素抵抗在脑小血管病诊断中的预测价值

The value of insulin resistance in predicting cerebral small vessel disease

目的探究胰岛素抵抗(IR)在临床中对脑小血管病(CSVD)诊断的预测价值。方法选取2019年8月-2020年12月就诊于嘉兴学院附属医院的住院患者,其中CSVD患者118例,非CSVD患者54例。所有入组患者计算胰岛素抵抗指数(HOMA-IR),以HOMA-IR≥3作为诊断IR的阈值,得到IR组患者84例,非IR组88例。CSVD患者根据影像学特征进行程度分级(0~4分):其中0~1分为轻度;2分为中度;3~4分为重度。将各种脑血管危险因素进行组间比较,并利用二元Logistic回归方法分析CSVD与IR的相关性,最后通过ROC曲线评估IR在诊断CSVD中的预测价值。结果在CSVD组中,IR患者的比例随着CSVD评分的增加而增加。轻度CSVD组与中重度CSVD组中IR的占比差异具有统计学意义(P <0.05)。非CSVD组的HOMA-IR值显著低于CSVD组1.9(IQR:1.0~4.2) vs 3.7(IQR:1.5~5.1)(P <0.05)。多元Logistic回归分析后发现IR作为CSVD的危险因子,其OR值为1.18(95%CI 1.01~1.38)(P <0.05)。ROC曲线显示HOMA-IR指数在诊断CSVD中的最佳截取值为2.54,其预测CSVD的敏感性为65.25%,特异性62.96%(P=0.004)。结论 IR在CSVD的诊断中具有一定的预测价值,它在CSVD的发病及进展等方面均有参与。

Objective The study aims to explore the value of insulin resistance( IR) in predicting the occurrence of cerebral small vessel disease( CSVD). Methods A total of 172 patients were enrolled in the Affiliated Hospital of Jiaxing University from August 2019 to December 2020. HOMA-IR index was calculated according to the formula and the 3. 0 value was the cut-off point of IR. All patients were divided into CSVD group and non-CSVD group or IR group and non-IR group. The total CSVD score was calculated according to the presence of each CSVD feature on MR from 0 to 4 using a recent described score rule. The relationship between CSVD and HOMA-IR was analyzed via the dichotomy logistic method. And the receiver operating characteristic curve( ROC curve) was used to evaluate the accuracy and specificity of HOMA-IR for predicting CSVD. Results The results showed the IR ratio rises with the increase of CSVD score. We compared the difference in the proportion of IR between mild CSVD and moderate-to-severe CSVD with the result of 44. 1% vs 66. 1%( P < 0. 05). HOMA-IR in non-CSVD group was significantly lower than those in CSVD group 1. 9( IQR: 1. 0 ~ 4. 2) compared with 3. 7( IQR: 1. 5 ~ 5. 1)( P < 0. 05). The result of OR value for multiple logistic regression analysis was 1. 18( 95% CI 1. 01 ~ 1. 38)( P < 0. 05). ROC curve shows the sensitivity and specificity of the optimal cut-off value,marked as 2. 54,were 65. 25% and 62. 96%( P = 0. 004). Conclusion IR has a certain predictive value in the diagnosis of CSVD. It is involved in the pathogenesis and progression of CSVD.