Total burden of cerebral small vascular disease and triglyceride glucose body mass index predict early neurological

doi:10.3877/cma.j.issn.2095-8757.2025.04.003

Abstract

Abstract:

Objective

To investigate the predictive value of total load of cerebral small vascular disease (CSVD) and triacyl-glucose body mass index (TyG-BMI) in early neurologic deterioration (END) of rt-PA intravenous thrombolysis in elderly patients with acute anterior circulation cerebral infarction over 60 years old.

Methods

Elderly patients aged over 60 years old with acute anterior circulation cerebral infarction who were hospitalized in the First People's Hospital of Suqian from July 2021 to July 2024 after rt-PA intravenous thrombolysis were retrospectively included. According to whether the NIHSS score has increased by≥4 points within 24 hours of intravenous thrombolysis, the patients were divided into END group and non END group. Clinical data and hematological indicators were collected. TyG-BMI was calculated. T test or Chi-square test was used to compared between the two groups. Total burden of CSVD was obtained based on MR Images. Multivariate Logistic regression analysis was used to determine the risk factors of END. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of risk factors to END.

Results

A total of 242 old patients with acute anterior circulation cerebral infarction were included, including 67 patients in the END group and 175 patients in the non-END group. The results of the univariate analysis indicated that there were statistically significant differences in age, BMI, baseline NIHSS score, atrial fibrillation (AF), FPG, TG, LDL-C, TyG-BMI and total burden of CSVD in the END group (P < 0.05). Multivariate logistic regression analysis showed that Age, baseline NIHSS score, AF, total burden of CSVD and TyG-BMI were risk factors for END (P < 0.05). ROC curve analysis showed that the area under the curve for predicting END using total burden of CSVD and TyG-BMI were 0.763 (95%CI: 0.702-0.854, P < 0.01) and 0.755 (95%CI: 0.698-0.835, P < 0.01). The optimal cut-off values were 2.5 points and 218.74, respectively.

Conclusion

Both the total load of CSVD and the TyG-BMI have certain predictive value for END in elderly patients over 60 years old with acute anterior circulation cerebral infarction after rt-PA intravenous thrombolysis, and their combination offers higher predictive value.

Key words: Cerebral infarction, Cerebral small vessel diseases, Total load of cerebral small vascular disease, Triacyl-glucose body mass, cerebral infarction, intravenous thrombolysis, early neurologic deterioration

Hu Huang, Chunjie Song, Yuanyan Han. Total burden of cerebral small vascular disease and triglyceride glucose body mass index predict early neurological[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2025, 12(04): 14-20.

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References 39

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项目	0分（n=36）	1分（n=65）	2分（n=79）	3分（n=53）	4分（n=9）	检验值	P值
年龄（岁，±s）	64.94±4.23	65.27±4.71	68.76±7.24	69.92±9.58	72.83±10.11	F=21.426	0.006
男性[例（%）]	15（41.67）	39（60.00）	51 （64.56）	35（66.04）	5（55.56）	χ²=6.599	0.159
高血压病[例（%）]	21（58.33）	38（58.46）	59 （74.68）	42（79.25）	8（88.89）	χ²=10.810	0.029
糖尿病[例（%）]	6（16.67）	16（24.61）	31（39.24）	25（47.17）	4（44.44）	χ²=12.892	0.012
冠心病[例（%）]	8（22.22）	14 （21.54）	18（22.78）	18（33.96）	3（33.33）	χ²=3.350	0.501
房颤[例（%）]	1（2.78）	5（7.69）	8（10.13）	8（15.09）	3（33.33）	χ²=9.148	0.058
吸烟[例（%）]	9（25.00）	22（33.85）	25（31.65）	24 （45.28）	5（55.56）	χ²=6.135	0.189
BMI（kg/m²，±s）	24.47±2.38	25.57±2.89	26.79±3.54	27.66±4.38	26.93±3.95	F=10.738	0.064
sICH[例（%）]	0	2（3.08）	4（5.06）	6（11.32）	2（22.22）	χ²=10.602	0.031
基线NIHSS评分[分，M（Q1，Q3）]	5（4,7）	5（4,7）	6（4,9）	7（5,9.5）	7（5,10）	Z=24.656	<0.001
血液指标（±s）
FPG（mmol/L）	6.73±0.47	6.64±0.93	7.15±0.87	6.82±1.04	7.22±1.09	F=0.284	0.538
HbA1c（%）	6.40±0.87	6.43±1.01	6.65±1.02	6.81±0.94	6.94±1.52	F=18.654	0.037
TC（mmol/L）	4.54±1.79	4.62±1.23	4.74±1.46	4.81±1.21	4.82±0.98	F=0.364	0.518
TG（mmol/L）	1.27±0.54	1.39±0.68	1.26±0.62	1.25±0.44	1.34±0.55	F=0.264	0.813
HDL-C（mmol/L）	1.18±0.24	1.21±0.19	1.20±0.21	1.17±0.23	1.19±0.15	F=0.1542	0.853
LDL-C（mmol/L）	2.67±0.82	2.82±0.88	2.99±0.93	2.89±1.04	2.79±1.21	F=0.693	0.521
TyG-BMI[M（Q1，Q3）]	189.54（169.47，211.53）	191.33（172.52，213.66）	217.37（186.49，230.54）	226.82（198.37，239.61）	229.17（204.26，248.47）	Z=27.875	<0.001

项目	0分（n=36）	1分（n=65）	2分（n=79）	3分（n=53）	4分（n=9）	检验值	P值
年龄（岁，±s）	64.94±4.23	65.27±4.71	68.76±7.24	69.92±9.58	72.83±10.11	F=21.426	0.006
男性[例（%）]	15（41.67）	39（60.00）	51 （64.56）	35（66.04）	5（55.56）	χ²=6.599	0.159
高血压病[例（%）]	21（58.33）	38（58.46）	59 （74.68）	42（79.25）	8（88.89）	χ²=10.810	0.029
糖尿病[例（%）]	6（16.67）	16（24.61）	31（39.24）	25（47.17）	4（44.44）	χ²=12.892	0.012
冠心病[例（%）]	8（22.22）	14 （21.54）	18（22.78）	18（33.96）	3（33.33）	χ²=3.350	0.501
房颤[例（%）]	1（2.78）	5（7.69）	8（10.13）	8（15.09）	3（33.33）	χ²=9.148	0.058
吸烟[例（%）]	9（25.00）	22（33.85）	25（31.65）	24 （45.28）	5（55.56）	χ²=6.135	0.189
BMI（kg/m²，±s）	24.47±2.38	25.57±2.89	26.79±3.54	27.66±4.38	26.93±3.95	F=10.738	0.064
sICH[例（%）]	0	2（3.08）	4（5.06）	6（11.32）	2（22.22）	χ²=10.602	0.031
基线NIHSS评分[分，M（Q1，Q3）]	5（4,7）	5（4,7）	6（4,9）	7（5,9.5）	7（5,10）	Z=24.656	<0.001
血液指标（±s）
FPG（mmol/L）	6.73±0.47	6.64±0.93	7.15±0.87	6.82±1.04	7.22±1.09	F=0.284	0.538
HbA1c（%）	6.40±0.87	6.43±1.01	6.65±1.02	6.81±0.94	6.94±1.52	F=18.654	0.037
TC（mmol/L）	4.54±1.79	4.62±1.23	4.74±1.46	4.81±1.21	4.82±0.98	F=0.364	0.518
TG（mmol/L）	1.27±0.54	1.39±0.68	1.26±0.62	1.25±0.44	1.34±0.55	F=0.264	0.813
HDL-C（mmol/L）	1.18±0.24	1.21±0.19	1.20±0.21	1.17±0.23	1.19±0.15	F=0.1542	0.853
LDL-C（mmol/L）	2.67±0.82	2.82±0.88	2.99±0.93	2.89±1.04	2.79±1.21	F=0.693	0.521
TyG-BMI[M（Q1，Q3）]	189.54（169.47，211.53）	191.33（172.52，213.66）	217.37（186.49，230.54）	226.82（198.37，239.61）	229.17（204.26，248.47）	Z=27.875	<0.001

因素	无END组（n=175）	END组（n=67）	检验值	P值
年龄（岁，±s）	68.94±8.47	70.82±9.26	t=1.654	0.038
男性[例（%）]	107（61.14）	38（56.72）	χ²=0.395	0.530
高血压病[例（%）]	118（67.42）	50（74.63）	χ²=1.183	0.277
糖尿病[例（%）]	50（28.57）	22（32.84）	χ²=0.422	0.516
冠心病[例（%）]	41（23.43）	20（29.85）	χ²=1.060	0.303
房颤[例（%）]	9（5.14）	16（23.88）	χ²=18.464	<0.001
吸烟史[例（%）]	57（32.57）	28 （41.79）	χ²=1.807	0.179
BMI（kg/m²，±s）	25.65±3.27	26.83±3.64	t=3.157	0.021
基线NIHSS评分[分，M（Q₁，Q₃）]	5（4，7）	7（4，8）	Z=-2.471	0.018
FPG（mmol/L，±s）	6.73±1.65	7.13±2.21	t=3.487	<0.001
TC（mmol/L，±s）	4.66±1.59	4.83±1.77	t=1.674	0.082
TG（mmol/L，±s）	1.24±0.41	1.33±0.39	t=2.016	0.022
HDL-C（mmol/L，±s）	1.19±0.19	1. 20±0.18	t=0.457	0.462
LDL-C（mmol/L，±s）	2.67±0.75	2.92±0.81	t=4.012	0.011
HbA1c（%，±s）	6.44±0.89	6.65±0.97	t=0.875	0.388
TyG-BMI[M（Q₁，Q₃）]	209.22（187.87，229.79）	228.43（197.54，241.29）	Z=-3.167	0.015
LI[例（%）]	131（74.86）	52（77.61）	χ²=0.199	0.655
WMH[例（%）]	59（33.71）	38（56.72）	χ²=10.674	0.001
CMB[例（%）]	33（18.86）	22（32.84）	χ²=5.391	0.020
PVS[例（%）]	19（10.86）	18（26.87）	χ²=9.587	0.002
CSVD总负荷[0分/1分/2分/3分/4分，例]	31/56/61/24/3	5/9/18/29/6	χ²=36.763	<0.001

因素	无END组（n=175）	END组（n=67）	检验值	P值
年龄（岁，±s）	68.94±8.47	70.82±9.26	t=1.654	0.038
男性[例（%）]	107（61.14）	38（56.72）	χ²=0.395	0.530
高血压病[例（%）]	118（67.42）	50（74.63）	χ²=1.183	0.277
糖尿病[例（%）]	50（28.57）	22（32.84）	χ²=0.422	0.516
冠心病[例（%）]	41（23.43）	20（29.85）	χ²=1.060	0.303
房颤[例（%）]	9（5.14）	16（23.88）	χ²=18.464	<0.001
吸烟史[例（%）]	57（32.57）	28 （41.79）	χ²=1.807	0.179
BMI（kg/m²，±s）	25.65±3.27	26.83±3.64	t=3.157	0.021
基线NIHSS评分[分，M（Q₁，Q₃）]	5（4，7）	7（4，8）	Z=-2.471	0.018
FPG（mmol/L，±s）	6.73±1.65	7.13±2.21	t=3.487	<0.001
TC（mmol/L，±s）	4.66±1.59	4.83±1.77	t=1.674	0.082
TG（mmol/L，±s）	1.24±0.41	1.33±0.39	t=2.016	0.022
HDL-C（mmol/L，±s）	1.19±0.19	1. 20±0.18	t=0.457	0.462
LDL-C（mmol/L，±s）	2.67±0.75	2.92±0.81	t=4.012	0.011
HbA1c（%，±s）	6.44±0.89	6.65±0.97	t=0.875	0.388
TyG-BMI[M（Q₁，Q₃）]	209.22（187.87，229.79）	228.43（197.54，241.29）	Z=-3.167	0.015
LI[例（%）]	131（74.86）	52（77.61）	χ²=0.199	0.655
WMH[例（%）]	59（33.71）	38（56.72）	χ²=10.674	0.001
CMB[例（%）]	33（18.86）	22（32.84）	χ²=5.391	0.020
PVS[例（%）]	19（10.86）	18（26.87）	χ²=9.587	0.002
CSVD总负荷[0分/1分/2分/3分/4分，例]	31/56/61/24/3	5/9/18/29/6	χ²=36.763	<0.001

变量	B值	SE值	Wald χ²值	OR值（95%CI）	P值
年龄	0.417	0.202	3.257	1.746（1.438～2.815）	0.018
BMI	0.279	0.115	1.384	1.462（0.874～2.057）	0.192
基线NIHSS评分	0.821	0.254	7.936	2.251（1.733～5.696）	<0.001
房颤	0.762	0.253	5.336	1.892（1.203～3.277）	<0.05
TG	0.157	0.085	1.812	1.237（0.893～2.695）	>0.05
LDL-C	0.486	0.207	2.054	1.371（0.884～2.156）	>0.05
TyG-BMI	0.978	0.352	9.216	1.904（1.137～3.018）	<0.001
CSVD总负荷	0.862	0.358	13.242	3.133（1.863～6.878）	<0.001

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