胰岛素抵抗与急性缺血性卒中静脉溶栓临床结局的相关性研究

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DOI：10.16424/j.cnki.cn32-1807/r.2025.05.014

[中图分类号]R743.3 [文献标志码]A [文章编号] 1674-7887（2025）05-0473-05

Correlation analysis on insulin resistance and clinical outcome of acute ischemic stroke patients treatedwithintravenousthrombolysis

WANG Hanl*，DAI Jiel，MIAO Jin²，ZHU Xiangyangt** （Department for Neurology，the Second Affiliated Hospital of Nantong University， Jiangsu 226O14; ²Laboratory Animal Center of Nantong University）

[Abstract]Objective：To explore theefectof insulinresistanceontheclinicaloutcomeofacute ischemic stroke（AIS）patients treatedwithintravenousthrombolysis.Methods：FromAugust2023toJulyO24，retrospectivelycolecting3O2ASpatients treatedwithrecombinanttissue typeplasminogenactivator（rt-PA）intravenousthrombolysiswithin4.5hafteronsetatthe DepartmentofNeurologyof the SecondAfiliated HospitalofNantong University.The homeostasis modelassssmentof insulin resistance（HOMA-IR）wasusedtoevaluateIR.Participants werecategorized intoquartilesbasedonHOMA-IRvalues，withthe highest quartile（Q4） definedastheIR group and the Q1- Q3 defined as the non-IR group.Patient's general information and clinical features wererecorded.Toanalyzetheassociationbetween IRandmodifiedRankinscale（mRS）at90days，hemrhagic transformationandallcause mortalityResults：75patients intheIRgroupand227patientsinthenon-IRgroup.Compared withnon-IRgroup，therateofporprognosisat90days，hemorhagictransformation，andsymptomaticintracranialhemorrhagewere significantly higher in IR group with the outcome（ 60.0% vs 41.4% ， P =0.005; 28.0% vs 15.9% ， P =0.020;and 14.7% vs 4.4% ， P =0.002）respectively.There was no significant difference inall-cause mortality within90 days（14.7% vs 9.3 % ， P =0.186）.InthemultivariateLogisticregressionmodel，theresultsdemonstratedthatIRwasariskfactorforpoorprogosis （OR=3.91，95%CI： 1.06-14.44，P=0.041）.ROC showed that the AUC of HOMA-IR for predicting poor prognosis was 0.66（P< 0.05），withanoptimalcutoff valueof1.91.Concusion：IRcanincreasetheriskofhemorrhagictransformationandpooroutcome after thrombolysis.HOMA-IR can predict of the prognosis of thrombolysis.

[Key Words]acute ischemic stroke; insulinresistance; intravenous thrombolysis;clinical outcome; predictive

卒中是我国成人致死、致残的首位病因，且中国已成为卒中终生风险最高和疾病负担最重的国家。（剩余7828字）