甘油三酯-葡萄糖指数预测老年高血压患者发生卒中风险的研究

Study of triglyceride glucose index in predicting stroke in elderly hypertensive patients

目的探索并比较不同基线甘油三酯-葡萄糖(TYG)指数的老年高血压患者发生卒中风险,并分析卒中的危险因素。方法前瞻性队列研究。纳人2018年1月至2020年1月入住北京安贞医院的459例老年高血压患者。按照TYG指数的四分位数分为4组:Q1组(TYG≤8.02,114例)、Q2组(8.02<TYG≤8.37.115例)、Q3组(8.37<TYG≤8.85,115例)和Q4组(TYG>8.85,115例)。比较各组基线临床资料情况和随访2年的卒中发生情况(出血性卒中和缺血性卒中),Cox回归分析卒中的危险因素。结果459例老年高血压患者中,男性251例(54.7%),女性208例(45.3%),年龄65~79(71.7±6.2)岁。四组基线资料(均P<0.05)。中位随访33个月,失访55例,50例(10.9%)患者发生卒中,包括17例(3.7%)出血性卒中和33例(7.2%)缺血性卒中。Q1、Q2、Q3和Q4组分别有6例(5.3%)、10例(8.7%)、15例(13.0%)和19例(16.2%)卒中。Kaplan-meier生存分析结果显示,与Q1组相比,Q2、Q3组和Q4组的卒中发生风险分别增加1.016倍(95%CI:0.933~1.106,P=0.715)、1.264倍(95%CI:1.067~1.497,P=0.007)和1.472倍(95%CI:1.119~1.936,P=0.006)。其中,Q3组和Q4组的缺血性卒中发生风险均增加(分别为HR=1.313,95%CI:1.016~1.697.P=0.037;HR=1.509,95%CI:1.113~2.046.P=0.008),Q4组的出血性卒中发生风险增加(HR=1.132,95%CI:1.021~1.255,P=0.019)。多因素Cox回归分析结果提示,男性(HR=1.336)、吸烟史(HR=1.485)、高脂血症(HR=1.216)、既往卒中(HR=1.547)、睡眠呼吸暂停(HR=1.484)、舒张压(HR=1.114)、血红蛋白(HR=0.962)、白蛋白/肌酐比(HR=1.318)、低密度脂蛋白胆固醇(HR=1.125)、TYG指数(HR=1.293)、左心室质量指数(HR=1.103)和抗血小板治疗(HR=0.874)是发生卒中的相关因素。结论TYG指数与老年高血压患者随访发生卒中风险,特别是缺血性卒中风险相关,提示TYG指数在优化患者脑血管风险分层方面可能具有临床应用价值。

Objective To investigate the risk of stroke in elderly hypertensive(HTN)patients with varying baseline triglyceride glucose(TYG)index,and to identify the risk factors associated with strokein this population.Methods This study was a prospective cohort study that included 459 elderly patients with hypertension who were admitted to Beijing Anzhen Hospital from January 2018 to January 2020.The patients were divided into four groups based on their quartile of TYG index:Q1 group(TYG index<8.02,114 cases),Q2 group(8.02<TYG≤8.37,115 cases),Q3 group(8.37<TYG<8.85,115 cases)and Q4 group(TYG>8.85,115 cases).The study compared the baseline clinical data and incidence of stroke(hemorrhagic or ischemic stroke)after two years of follow-up among the four groups,and analyzed the risk factors of stroke using Cox regression analyses.Results This study examined 459 elderly patients with hypertension,of which 251(54.7%)were male and 208(45.3%)were female,with an average age of(71.7±6.2)years(65-79 years).The study found significant differences among the four groups in various factors(P<0.O5 for all).The study followed up with patients for a median of 33 months,55 cases were lost to follow-up.Out of the remaining patients,10.9%experienced stroke,with 3.7%being hemorrhagic stroke and 7.2%being ischemic stroke.The occurrence of stroke was observed in 5.3%,8.7%,13.0%,and 16.2%of patients in the Q1,Q2,Q3,and Q4 groups,respectively.The results of Kaplan-Meier survival analysis demonstrated that the risk of stroke increased gradually as the quartile increased.Specifically,compared to the Q1 group,the risk of stroke increased by 1.016 times(95%CI:0.933-1.106,P=0.715),1.264 times(95%CI:1.067-1.497,P=0.007),and 1.472 times(95%CI:1.119-1.936,P=0.006)in the Q2,Q3,and Q4 groups,respectively.Notably,both Q3 and Q4 groups showed a significant increase in the risk of ischemic stroke(HR=1.313,95%CI:1.016-1.697,P=0.037;HR=1.509,95%CI:1.113-2.046,P=0.008),while the Q4 group showed a significant increase in the risk of hemorrhagic stroke(HR=1.132,95%CI:1.021-1.255,P=0.019).Multivariate Cox regression analysis showed that male(HR=1.336),smoking history(HR=1.485),hyperlipidemia(HR=1.216),previous stroke(HR=1.547),sleep apnea(HR=1.484),diastolic blood pressure(HR=1.114),hemoglobin(HR=0.962),albumin/creatinine ratio(HR=1.318),low-density lipoprotein cholesterol(HR=1.125),TYG index(HR=1.293),left ventricular mass index(HR=1.103),and anti-platelet therapy(HR=0.874)were all found to be independent risk factors for stroke.Conclusions In elderly patients with hypertension,there is a significant positive correlation between TYG index and stroke risk,particularly ischemic stroke.This suggests that TYG index could be clinically valuable in improving cerebrovascular risk stratification.