| Aims:This study aims to investigate the association between insulin resistance(IR),fasting insulin and silent cerebral infarction(SCI)in the non-diabetics.In order to provide theoretical basis for clinical prevention and treatment in the future.Methods:This was a retrospective-prospective study of 236 patients who were admitted to the department of physical examination center of the second affiliated Hospital of Dalian Medical University from January 2017 to October 2017.Among them,32 patients with clinical cerebral infarction or with specific symptoms and signs of cerebral infarction were excluded,the remaining 204 patients were selected as the subjects of this study.Every cases have been underwent brain magnetic resonance imaging(MRI)examination in our study.According to the presence or absence of SCI lesions in brain imaging examination,we divided the patients into SCI group(n=41 cases)and non-SCI group(n=163 cases).Access to clinical records,collect and arrange clinical information including age,gender,smoking,drinking,hypertension,coronary disease,atrial fibrillation,carotid atherosclerosis(CAS),total cholesterol(TC),fasting blood-glucose,fasting insulin.IR was estimated by the homeostasis model assessment insulin resistance(HOMA-IR),and the cutoff value for its diagnosis was 2.56.According to the number of lesions in SCI group,the patients were divided into two groups:n=1 group and n≥ 2 group.The correlation between IR and the number of SCI was compared.To identify the association between IR,fasting insulin and SCI,as well as whether the independent risk factors predisposing to the presence of SCI,multivariate logistic regression analysis were done using variables with P values<0.05 in univariate analysis.Finally,Receiver Operating Characteristic(ROC)curve and the corresponding area under the curve were computed for fasting insulin.To find the optimal cutoff value as the prediction index of SCI.Results:1.There are 204 cases in our study,the incidence of SCI and IR were 20.1%and19.1% respectively.The mean age of the study population was 59.23±8.97 years old,(40 to 79 years old),male 108 cases(52.9%).Including 41 SCI cases,mean age 65.02±8.26 years old,23 males(56.1%),and 163 non-SCI cases,mean age 57.77±8.56 years old,85 males(52.1%).There were 25 cases in n=1 group,including 5 cases with IR,20 cases with non-IR and 16 cases in n≥2 group,including10 cases with IR and 6 cases with non-IR.2.Between the SCI group and the non-SCI group,there were no statistical difference(P≥0.05)in gender,smoking,drinking,atrial fibrillation,hypercholesterolemia,fasting blood-glucose.There were statistical difference(P<0.05)in age,hypertension,coronary disease,CAS,fasting insulin,HOMA-IR.3.Multivariate logistic regression analysis were done using variables with age,hypertension,coronary disease,atherosclerosis,fasting insulin,HOMA-IR in univariate analysis.Results:age(OR,1.09;95%CI,1.03-1.15;P<0.05),hypertension(OR,1.30;95%C I,1.01-1.67;P<0.05),HOMA-IR(OR,2.65;95%CI,1.39-5.09;P<0.05),and IR(OR,1.18;95%CI,1.07-1.30;P<0.05)were independent risk factors for SCI.4.The difference of HOMA-IR between group1 and group2 was statistically significant by χ2 test(P<0.05).5.The ROC curve analysis of fasting insulin showed that the AUC of fasting insulin was 0.76,and the optimum cutoff value was 9.15 m IU/L and the sensitivity was 0.71.The specificity was 0.76.Conclusions:1.Multivariate logistic regression analyses revealed that the age,hypertension,fasting insulin,IR were independent risk factors for SCI.And IR was an independent risk factor of SCI presence and its multiple.3.Clinical improvement of insulin resistance may reduce the occurrence and progression of SCI.The concentration of fasting insulin more than 9.15 m IU/L can be used as a predictor of SCI. |
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