β-Cell Function and Clinical Outcome in Nondiabetic Patients With Acute Ischemic Stroke

Stroke - Tập 52 Số 8 - Trang 2621-2628 - 2021
Takuya Kiyohara1,2, Ryu Matsuo3,4,5, Jun Hata6,7, Kuniyuki Nakamura8, Yoshinobu Wakisaka9, Masahiro Kamouchi3,10, Takanari Kitazono3,11, Tetsuro Ago12, Takao Ishitsuka, Setsuro Ibayashi, Kenji Kusuda, Kenichiro Fujii, T Nagao, Yasushi Okada, Masahiro Yasaka10, Hiroaki Ooboshi, Tsuyoshi Omae, Ḱazunori Toyoda, Hiroshi Nakane, Hiroshi Sugimori, Shuji Arakawa, Kenji Fukuda, Jiro Kitayama, Shigeru Fujimoto, Shoji Arihiro, Junya Kuroda, Yoshihisa Fukushima, Yasuhiro Kumai
1Department of Cerebrovascular Disease and Neurology, Hakujyuji Hospital, Fukuoka, Japan (T. Kiyohara).
2Takuya Kiyohara https://orcid.org/0000-0002-8819-1109 Department of Medicine and Clinical Science (T. Kiyohara, R.M., J.H., K.N., Y.W., T. Kitazono, T.A.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Department of Cerebrovascular Disease and Neurology, Hakujyuji Hospital, Fukuoka, Japan (T. Kiyohara).
3Center for Cohort Studies (R.M., M.K., T. Kitazono), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
4Department of Health Care Administration and Management (R.M., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
5Department of Medicine and Clinical Science (T. Kiyohara, R.M., J.H., K.N., Y.W., T. Kitazono, T.A.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
6Department of Epidemiology and Public Health (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
7Jun Hata https://orcid.org/0000-0003-2698-344X Department of Medicine and Clinical Science (T. Kiyohara, R.M., J.H., K.N., Y.W., T. Kitazono, T.A.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Department of Epidemiology and Public Health (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
8Kuniyuki Nakamura https://orcid.org/0000-0002-9918-8802 Department of Medicine and Clinical Science (T. Kiyohara, R.M., J.H., K.N., Y.W., T. Kitazono, T.A.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
9Yoshinobu Wakisaka Department of Medicine and Clinical Science (T. Kiyohara, R.M., J.H., K.N., Y.W., T. Kitazono, T.A.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
10Masahiro Kamouchi https://orcid.org/0000-0002-5348-8762 Department of Health Care Administration and Management (R.M., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Center for Cohort Studies (R.M., M.K., T. Kitazono), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
11Takanari Kitazono Department of Medicine and Clinical Science (T. Kiyohara, R.M., J.H., K.N., Y.W., T. Kitazono, T.A.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Center for Cohort Studies (R.M., M.K., T. Kitazono), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
12Tetsuro Ago https://orcid.org/0000-0003-4560-6594 Department of Medicine and Clinical Science (T. Kiyohara, R.M., J.H., K.N., Y.W., T. Kitazono, T.A.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Tóm tắt

Background and Purpose: Little is known about how β-cell dysfunction affects clinical outcome after ischemic stroke. We examined whether β-cell function is associated with clinical outcome after acute ischemic stroke and if so, whether insulin resistance influences this association in a prospective study of patients with acute stroke. Methods: A total of 3590 nondiabetic patients with acute ischemic stroke (mean age, 71 years) were followed up for 3 months. β-Cell function was assessed using the homeostasis model assessment for β-cell function (HOMA-β). Study outcomes were poor functional outcome (modified Rankin Scale score, 3–6) and stroke recurrence at 3 months after stroke onset and neurological deterioration (≥2-point increase in the National Institutes of Health Stroke Scale score) at discharge. Logistic regression analysis was used to evaluate the association between quintile levels of serum HOMA-β and clinical outcomes. Results: The age- and sex-adjusted odds ratios for poor functional outcome and neurological deterioration increased significantly with decreasing HOMA-β levels ( P for trend, <0.001 and 0.001, respectively). These associations became more prominent after adjustment for HOMA-insulin resistance and were substantially unchanged even after further adjustment for other confounders, namely, body mass index, dyslipidemia, hypertension, estimated glomerular filtration rate, stroke subtype, National Institutes of Health Stroke Scale score on admission, and reperfusion therapy (odds ratio [95% CI] for the first versus fifth quintile of HOMA-β, 3.30 [2.15–5.08] for poor functional outcome and 10.69 [4.99–22.90] for neurological deterioration). Such associations were not observed for stroke recurrence. In stratified analysis for the combination of HOMA-β and HOMA-insulin resistance levels, lower HOMA-β and higher HOMA-insulin resistance levels were independently associated with increased risks of poor functional outcome and neurological deterioration. Conclusions: Our findings suggest that β-cell dysfunction is significantly associated with poor short-term clinical outcome independently of insulin resistance in nondiabetic patients with acute ischemic stroke.

Từ khóa


Tài liệu tham khảo

10.1016/S2214-109X(13)70089-5

10.1007/s00125-002-1009-0

10.1007/BF00403379

10.2337/diacare.25.7.1135

10.1371/journal.pone.0052036

10.1212/WNL.0000000000005358

10.1161/STROKEAHA.116.015613

10.1111/ene.13546

10.1161/STROKEAHA.117.018203

10.2337/diab.42.11.1663

10.1161/STROKEAHA.111.617415

10.1212/WNL.0b013e318259e110

10.1111/j.2040-1124.2010.00074.x

10.1007/BF00280883

Japan Diabetes Society. In: Japan Diabetes Society ed. Treatment Guide for Diabetes 2010. Bunkodo; 2010:11–12 (in Japanese).

10.1253/circj.66.987

10.1053/j.ajkd.2008.12.034

10.1161/01.str.24.1.35

10.1185/030079908x253573

10.1097/HJH.0000000000000842

10.1155/2013/151675

10.2337/diabetes.51.2007.s212

10.1111/dom.13005

10.1172/JCI118124

10.1172/JCI118871

10.1038/jcbfm.2011.181

10.1515/bmc-2019-0002

10.1093/bmb/ldq008

10.1371/journal.pone.0162603

10.2337/diacare.26.12.3320

10.1210/jc.2010-1144

10.1530/eje.0.1500097

10.2337/diacare.27.6.1487

10.1161/01.str.25.7.1481

10.1007/s11892-015-0602-9

10.1007/s00125-014-3414-6

Thông tin
Thông tin xuất bản

Stroke

Tập 52 Số 8

2621-2628

Thông tin tác giả