Effect Of TyG Index And Peripheral Inflammation In The Acute Phase Of Cerebral Infarction On Neurological Deficits Of Patients

Object:In this study,patients with acute anterior circulation cerebral infarction with NIHSS of 1-15 were enrolled to investigate the effect of triglyceride-glucose（TyG）index,serum inflammatory mediators and specialized pro-resolving lipid mediators（SPMs）in the acute phase of cerebral infarction on the severity of neurological deficits and early prognosis of patients;and to analyze the relationship between TyG index and serum inflammatory mediators and SPMs and the predictive value of TyG index on the severity of neurological deficits and early prognosis in patients with acute cerebral infarction.Methods:1.According to the inclusion and exclusion criteria,patients with acute anterior circulation cerebral infarction within 72 hours of onset and with NIHSS of 1-15 who were hospitalized in the Department of Neurology of our hospital from October 2016 to October 2022 were selected.Age and sex matched volunteers without history of cerebral infarction and inflammation related diseases were also recruited as control group.The NIHSS at admission and m RS at discharge were assessed and recorded.The general clinical data and laboratory indexes were also collected.Fasting blood samples were collected in the early morning of the next day of hospitalization,which were used to detect fasting blood glucose and triglycerides,then the TyG index was calculated by the formula “TyG index = Ln [triglycerides（mg/dl）× fasting blood glucose（mg/dl）/2]” as an index of insulin resistance.The levels of serum inflammatory cytokines IL-2,IL-4,IL-6,IL-10,IL-17 A,TNF-α and IFN-γ were detected by cytometric bead array（CBA）,and the levels of specialized pro-resolving lipid mediator Rv D1 and pro-inflammatory mediator LTB₄ were detected by enzyme linked immunosorbent assay（ELISA）.2.Patients with acute cerebral infarction were divided into mild neurological deficit group（1≤ NIHSS ≤ 4）and moderate neurological deficit group（4（27）NIHSS ≤15）according to the NIHSS at admission and analyzed the difference in the levels of the above indicators between the two groups.3.Patients in the mild and moderate neurological deficit groups were analyzed in subgroups by dividing them into early good prognosis group（m RS≤2）and early poor prognosis group（2<m RS≤5）according to m RS at discharge,respectively.And the differences in the levels of the above indicators between the two subgroups were analyzed.4.To analyze the correlation between TyG index and serum inflammatory mediators and SPMs in patients with acute cerebral infarction.5.To analyze the predictive value of TyG index on the severity of neurological deficits and early poor prognosis in patients with acute cerebral infarction by plotting ROC curves.Results:1.Patients with acute cerebral infarction had higher levels of TyG index,serum inflammatory cytokines（IL-10,IL-6,IL-4,IL-2,IL17 A,IFN-γ and TNF-α）,Rv D1 and Rv D1/LTB₄ than control group（P<0.05）.2.The levels of TyG index,serum IL-6,TNF-α and LTB₄ in the moderate neurological deficit group were higher than those in the mild neurological deficit group（P<0.05）,while the levels of serum Rv D1 and Rv D1/LTB₄ in the moderate neurological deficit group were lower than those in the mild neurological deficit group（P<0.05）.There were no significant differences in the levels of other indicators between the two groups（P>0.05）.3.In the mild neurological deficit group,the TyG index in patients with poor early prognosis was higher than those in patients with good early prognosis（P<0.05）,while there were no significant differences in the levels of all the other indicators between the two subgroups（P>0.05）.In the moderate neurological deficit group,the levels of TyG index,serum IL-6 and LTB₄ in patients with poor early prognosis were higher than those in patients with good early prognosis（P<0.05）,while the level of Rv D1/LTB₄ in patients with poor early prognosis were lower than those in patients with good early prognosis（P<0.05）.However,there were no significant differences in the levels of other indicators between the two subgroups（P>0.05）.4.The level of TyG index in patients with acute cerebral infarction was positively correlated with the serum levels of IL-6,TNF-α and LTB₄（P<0.001）and negatively correlated with the serum level of Rv D1/LTB₄（P<0.05）.Whereas there were no significant correlations between the levels of TyG index and other indicators（P>0.05）.5.The AUC of TyG index for predicting severity of neurological deficits was0.841（95% CI 0.760-0.922,P<0.001）,with a best cut-off value of 8.95,and the sensitivity and specificity were 65.0% and 94.3%,respectively;the AUC of TyG index for predicting early poor prognosis was 0.779（95% CI 0.685-0.873,P<0.001）,with a best cut-off value of 8.73,and the sensitivity and specificity were 77.8% and65.9%,respectively.Conclusion:1.The levels of TyG index,serum IL-6,TNF-α,LTB₄,Rv D1 and Rv D1/LTB₄ affect the severity of neurological deficits in patients with acute cerebral infarction.2.In both mild and moderate neurological deficit groups,TyG index affect the early prognosis of patients,whereas serum levels of IL-6,LTB₄ and Rv D1/LTB₄ only affect the early prognosis of patients with moderate neurological deficits.3.The level of TyG index may affect the severity of neurological deficits and early prognosis in patients with acute cerebral infarction by regulating the levels of serum IL-6,TNF-α,LTB₄ and Rv D1/LTB₄.4.TyG index is a reliable indicator of the severity of neurological deficits and early poor prognosis in patients with acute cerebral infarction.