应激性高血糖比率与大动脉粥样硬化型脑梗死患者卒中后认知功能障碍的相关性OA
Association between stress hyperglycemia ratio and post-stroke cognitive dysfunction in patients with large-artery atherosclerotic cerebral infarction
目的 探讨应激性高血糖比率(SHR)与大动脉粥样硬化型脑梗死患者卒中后认知功能障碍(PSCI)的相关性.方法 连续性筛选2023年7月1日—2024年6月30日在北京京煤集团总医院住院的大动脉粥样硬化型脑梗死患者,共计1 222例纳入分析.根据SHR的三分位数水平,将患者分为3组:低值组(0.175～0.764,n=408),中值组(0.765～0.905,n=407)及高值组(0.906～2.760,n=407).采用单因素分析比较两组间相关指标的差异,采用单因素及多因素Logistic回归分析,找出PSCI发生的独立危险因素;使用限制性三次样条(RCS)来阐明SHR水平与PSCI发生的关联,并进行阈值效应分析.结果 所有随访的患者中,PSCI发生率为16.3%(199/1 222);高值组患者的年龄、平均动脉压(MAP)、入院时NIHSS评分、出院时MRS评分及PSCI发生率均增高,同时,MMSE评分及高学历占比显著降低(P均<0.05);在校正相关因素后,除年龄大、高低密度脂蛋白水平、高同型半胱氨酸水平、高血清肌酐、合并糖尿病病史及出院高MRS评分外,高SHR(OR=5.19,95%CI 3.15～8.55,P<0.001)是PSCI发生的独立危险因素;SHR与PSCI发生率呈"倒V"型的非线性关系(Pfor overall<0.001,Pfor nonlinear<0.001),且两者之间的关联存在阈值效应(Pfor likelihood test<0.001),即当SHR<1.28时,SHR和PSCI为正向关联(OR=93.26,95%CI 27.23～319.42),当SHR>1.28时,SHR和PSCI为负向关联(OR=0.08,95%CI 0.02～0.41).结论 在大动脉粥样硬化型脑梗死患者中,PSCI发生率较高;SHR与PSCI的发生呈"倒V"型的非线性关系.
Objective To investigate the association between stress hyperglycemia ratio(SHR)and post-stroke cogni-tive impairment(PSCI)in patients with large-artery atherosclerotic cerebral infarction.Methods The patients with large-artery atherosclerotic cerebral infarction who were consecutively admitted to Beijing Jingmei Group General Hospital from July 1,2023 to June 30,2024 were selected,and a total of 1 222 patients were included for analysis based on the inclusion and ex-clusion criteria.According to the tertiles of SHR,the patients were divided into low SHR group(L-SHR group,408 patients with an SHR of 0.175-0.764),middle SHR group(M-SHR group,407 patients with an SHR of 0.765-0.905),and high-SHR group(H-SHR group,407 patients with an SHR of 0.906-2.760).A univariate analysis was used for comparison of re-lated indicators between two groups,and the univariate and multivariate logistic regression analyses were used to identify the in-dependent influencing factors for PSCI;a restricted cubic spline analysis was used to clarify the association between SHR and PSCI,and a threshold effect analysis was performed.Results The incidence rate of PSCI was 16.3%(199/1 222)in all pa-tients undergoing follow-up.The H-SHR group had significant increases in age,MAP,NIHSS score on admission,MRS score at discharge,and the incidence rate of PSCI and significant reductions in MMSE score and the proportion of patients with a high education level(all P<0.05).After adjustment for related factors,high SHR(OR=5.19,95%CI 3.15-8.55,P<0.001)was an independent risk factor for PSCI in addition to old age,a high level of low-density lipoprotein,a high level of homocysteine,a high level of serum creatinine,a history of diabetes,and a high MRS score at discharge.There was an"inverted V-shaped"nonlinear relationship between SHR and the incidence rate of PSCI(Pfor overall<0.001,Pfor nonlinear<0.001),and there was a thresh-old effect in the relationship between them(Pfor likelihood test<0.001),;specifically,when SHR was less than 1.28,there was a positive association between SHR and PSCI(OR=93.26,95%CI 27.23-319.42),and when SHR was higher than 1.28,there was a negative association between SHR and PSCI(OR=0.08,95%CI 0.02-0.41).Conclusion There is a relatively high in-cidence rate of PSCI among patients with large-artery atherosclerotic cerebral infarction,and there is an"inverted V-shaped"non-linear relationship between SHR and the onset of PSCI.
王鹤;殷煜;牛利;张明建;连航钺;张丽霞;安娜
北京京煤集团总医院全科医疗科,北京 102399北京京煤集团总医院全科医疗科,北京 102399北京京煤集团总医院全科医疗科,北京 102399北京京煤集团总医院全科医疗科,北京 102399北京京煤集团总医院全科医疗科,北京 102399北京京煤集团总医院全科医疗科,北京 102399北京京煤集团总医院全科医疗科,北京 102399
医药卫生
卒中后认知功能障碍应激性高血糖比率脑梗死限制性三次样条分析
Post-stroke cognitive impair-mentStress hyperglycemia ratioCerebral infarc-tionRestricted cubic spline analysis
《中风与神经疾病杂志》 2026 (3)
238-243,6
北京京煤集团总医院科研基金(ZZ2024-45)
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