胰岛素抵抗在青年缺血性卒中发病与预后中的影响
The Impact of Insulin Resistanceon the Onset and Prognosis of Ischemic Stroke in Young Adults
DOI: 10.12677/acm.2026.161189, PDF,   
作者: 彭 燕*：昆明医科大学第二附属医院暨第二临床学院神经内科，云南 昆明；尹风琼：昆明医科大学临床技能中心，云南 昆明
关键词: 青年缺血性卒中；胰岛素抵抗；动脉粥样硬化；预后；Ischemic Stroke in Young Adults； Insulin Resistance； Atherosclerosis； Prognosis
摘要: 青年缺血性卒中的全球发病率呈显著上升态势，已成为亟待关注的公共卫生问题。尽管高血压、高血脂等传统卒中危险因素在青年人群中仍发挥作用，但胰岛素抵抗(insulin resistance, IR)的致病机制与预后影响尚未被充分阐明。现有研究证实，IR可通过诱发高血糖、高血脂、高血压及全身炎症等代谢紊乱，加速动脉粥样硬化进程，同时直接损伤血管内皮功能与脑组织代谢，构建多重致病通路，深刻影响青年缺血性卒中的发生、发展及预后。本文系统综述IR在青年缺血性卒中发病机制与预后中的核心作用，旨在为临床诊疗与二级预防提供科学参考。
Abstract: The global incidence of ischemic stroke in young adults is on the rise, becoming a public health issue that demands urgent attention. Although traditional stroke risk factors such as hypertension and hyperlipidemia still play a role in the young population, the pathogenic mechanism and prognostic impact of insulin resistance (IR) have not been fully elucidated. Existing studies have confirmed that insulin resistance can accelerate the process of atherosclerosis by inducing metabolic disorders such as hyperglycemia, hyperlipidemia, hypertension, and systemic inflammation, and directly damage vascular endothelial function and brain tissue metabolism, establishing multiple pathogenic pathways and profoundly influencing the occurrence, development, and prognosis of ischemic stroke in young adults. This article systematically reviews the core role of IR in the pathogenesis and prognosis of ischemic stroke in young adults, aiming to provide scientific references for clinical diagnosis, treatment, and secondary prevention.
文章引用：彭燕, 尹风琼. 胰岛素抵抗在青年缺血性卒中发病与预后中的影响[J]. 临床医学进展, 2026, 16(1): 1474-1481. https://doi.org/10.12677/acm.2026.161189

参考文献

[1] Fan, J., Li, X., Yu, X., Liu, Z., Jiang, Y., Fang, Y., et al. (2023) Global Burden, Risk Factor Analysis, and Prediction Study of Ischemic Stroke, 1990-2030. Neurology, 101, e137-e150. [Google Scholar] [CrossRef] [PubMed]
[2] Zhang, M., Long, Z., Liu, P., Qin, Q., Yuan, H., Cao, Y., et al. (2025) Global Burden and Risk Factors of Stroke in Young Adults, 1990 to 2021: A Systematic Analysis of the Global Burden of Disease Study 2021. Journal of the American Heart Association, 14, e039387. [Google Scholar] [CrossRef] [PubMed]
[3] Ciplak, S., Adiguzel, A., Deniz, Y.Z., Aba, M. and Ozturk, U. (2023) The Role of the Low-Density Lipoprotein/High-Density Lipoprotein Cholesterol Ratio as an Atherogenic Risk Factor in Young Adults with Ischemic Stroke: A Case-Control Study. Brain Sciences, 13, Article 1180. [Google Scholar] [CrossRef] [PubMed]
[4] Xu, W., Zhao, H., Han, X., Liu, J., Li, H., Sun, J., et al. (2023) Relationship between Early-Onset Stroke and Triglyceride-Glucose Index among Young Chinese Adults. Lipids in Health and Disease, 22, Article No. 3. [Google Scholar] [CrossRef] [PubMed]
[5] Crespo Pimentel, B., Willeit, J., Töll, T., Kiechl, S., Pinho e Melo, T., Canhão, P., et al. (2019) Etiologic Evaluation of Ischemic Stroke in Young Adults: A Comparative Study between Two European Centers. Journal of Stroke and Cerebrovascular Diseases, 28, 1261-1266. [Google Scholar] [CrossRef] [PubMed]
[6] Huang, Y., Li, Z. and Yin, X. (2024) Long-term Survival in Stroke Patients: Insights into Triglyceride-Glucose Body Mass Index from ICU Data. Cardiovascular Diabetology, 23, Article No. 137. [Google Scholar] [CrossRef] [PubMed]
[7] Petersen, M.C. and Shulman, G.I. (2018) Mechanisms of Insulin Action and Insulin Resistance. Physiological Reviews, 98, 2133-2223. [Google Scholar] [CrossRef] [PubMed]
[8] Liao, C., Xu, H., Jin, T., Xu, K., Xu, Z., Zhu, L., et al. (2023) Triglyceride-Glucose Index and the Incidence of Stroke: A Meta-Analysis of Cohort Studies. Frontiers in Neurology, 13, Article 1033385. [Google Scholar] [CrossRef] [PubMed]
[9] Gu, T., Yang, Q., Ying, G. and Jin, B. (2020) Lack of Association between Insulin Resistance as Estimated by Homeostasis Model Assessment and Stroke Risk: A Systematic Review and Meta-Analysis. Medical Hypotheses, 141, Article ID: 109700. [Google Scholar] [CrossRef] [PubMed]
[10] Hoshino, T., Mizuno, T., Ishizuka, K., Takahashi, S., Arai, S., Toi, S., et al. (2022) Triglyceride-Glucose Index as a Prognostic Marker after Ischemic Stroke or Transient Ischemic Attack: A Prospective Observational Study. Cardiovascular Diabetology, 21, Article No. 264. [Google Scholar] [CrossRef] [PubMed]
[11] Rao, X., Xin, Z., Yu, Q., Feng, L., Shi, Y., Tang, T., et al. (2025) Triglyceride-Glucose-Body Mass Index and the Incidence of Cardiovascular Diseases: A Meta-Analysis of Cohort Studies. Cardiovascular Diabetology, 24, Article No. 34. [Google Scholar] [CrossRef] [PubMed]
[12] Guo, Y., Zhao, J., Zhang, Y., Wu, L., Yu, Z., He, D., et al. (2021) Triglyceride Glucose Index Influences Platelet Reactivity in Acute Ischemic Stroke Patients. BMC Neurology, 21, Article No. 409. [Google Scholar] [CrossRef] [PubMed]
[13] Huo, R., Zhai, L., Liao, Q. and You, X. (2023) Changes in the Triglyceride Glucose-Body Mass Index Estimate the Risk of Stroke in Middle-Aged and Older Chinese Adults: A Nationwide Prospective Cohort Study. Cardiovascular Diabetology, 22, Article No. 254. [Google Scholar] [CrossRef] [PubMed]
[14] Takatori, S., Zamami, Y., Hashikawa-Hobara, N. and Kawasaki, H. (2013) Insulin Resistance-Induced Hypertension and a Role of Perivascular Cgrpergic Nerves. Current Protein & Peptide Science, 14, 275-281. [Google Scholar] [CrossRef] [PubMed]
[15] Pu, Y., Xing, N., Wang, Y., Wang, H., Xu, J. and Li, X. (2024) Differential Impact of Tyg and Tyg-BMI Indices on Short-And Long-Term Mortality in Critically Ill Ischemic Stroke Patients. BMC Cardiovascular Disorders, 24, Article No. 754. [Google Scholar] [CrossRef] [PubMed]
[16] Du, Z., Xing, L., Lin, M. and Sun, Y. (2020) Estimate of Prevalent Ischemic Stroke from Triglyceride Glucose-Body Mass Index in the General Population. BMC Cardiovascular Disorders, 20, Article No. 483. [Google Scholar] [CrossRef] [PubMed]
[17] Sojitra, M.H., Garg, V.S., Shah, K., Joshi, S., Vadnagara, H., Gandhi, S.K., et al. (2023) Exploring the Role of Insulin Resistance in Fueling Stroke Vulnerability and Worsening Post-Stroke Prognosis: A Narrative Review of Current Literature. Cureus, 15, e48034. [Google Scholar] [CrossRef] [PubMed]
[18] Zou, X., Li, Y., Zhang, S., Zhang, J., Wang, Y., Shi, S., et al. (2024) Relationship between Triglyceride-Glucose Index and Carotid Artery Plaques in Ischemic Stroke Patients: Based on Blood Pressure Status, Sex, and Age. Journal of Stroke and Cerebrovascular Diseases, 33, Article ID: 107992. [Google Scholar] [CrossRef] [PubMed]
[19] Wang, Y., Liu, T., Li, Y., Zhang, K., Fan, H., Ren, J., et al. (2023) Triglyceride-Glucose Index, Symptomatic Intracranial Artery Stenosis and Recurrence Risk in Minor Stroke Patients with Hypertension. Cardiovascular Diabetology, 22, Article No. 90. [Google Scholar] [CrossRef] [PubMed]
[20] Tagi, V.M., Giannini, C. and Chiarelli, F. (2019) Insulin Resistance in Children. Frontiers in Endocrinology, 10, Article 342. [Google Scholar] [CrossRef] [PubMed]
[21] Di Pino, A. and DeFronzo, R.A. (2019) Insulin Resistance and Atherosclerosis: Implications for Insulin-Sensitizing Agents. Endocrine Reviews, 40, 1447-1467. [Google Scholar] [CrossRef] [PubMed]
[22] Rivas, A.M. and Nugent, K. (2021) Hyperglycemia, Insulin, and Insulin Resistance in Sepsis. The American Journal of the Medical Sciences, 361, 297-302. [Google Scholar] [CrossRef] [PubMed]
[23] Tang, S., Wang, H., Li, K., Chen, Y., Zheng, Q., Meng, J., et al. (2024) C-Reactive Protein-Triglyceride Glucose Index Predicts Stroke Incidence in a Hypertensive Population: A National Cohort Study. Diabetology & Metabolic Syndrome, 16, Article No. 277. [Google Scholar] [CrossRef] [PubMed]
[24] Huang, Z., Ding, X., Yue, Q., Wang, X., Chen, Z., Cai, Z., et al. (2022) Triglyceride-Glucose Index Trajectory and Stroke Incidence in Patients with Hypertension: A Prospective Cohort Study. Cardiovascular Diabetology, 21, Article No. 141. [Google Scholar] [CrossRef] [PubMed]
[25] Stanciu, S.M., Jinga, M., Miricescu, D., Stefani, C., Nica, R.I., Stanescu-Spinu, I., et al. (2024) mTOR Dysregulation, Insulin Resistance, and Hypertension. Biomedicines, 12, Article 1802. [Google Scholar] [CrossRef] [PubMed]
[26] Li, Y., You, A., Tomlinson, B., Yue, L., Zhao, K., Fan, H., et al. (2021) Insulin Resistance Surrogates Predict Hypertension Plus Hyperuricemia. Journal of Diabetes Investigation, 12, 2046-2053. [Google Scholar] [CrossRef] [PubMed]
[27] Sánchez, D.C.V., Castellanos, S.G., Sandoval, M.E.V. and García, A.G. (2022) B-Cell Activating Factor Increases Related to Adiposity, Insulin Resistance, and Endothelial Dysfunction in Overweight and Obese Subjects. Life, 12, Article 634. [Google Scholar] [CrossRef] [PubMed]
[28] Deery, H.A., Liang, E., Di Paolo, R., Voigt, K., Murray, G., Siddiqui, M.N., et al. (2024) The Association of Regional Cerebral Blood Flow and Glucose Metabolism in Normative Ageing and Insulin Resistance. Scientific Reports, 14, Article No. 14574. [Google Scholar] [CrossRef] [PubMed]
[29] Sun, Y., Deng, W., Luo, L. and Chen, M. (2025) Effect of Insulin Resistance on Prognosis of Intravenous Thrombolysis in Acute Ischemic Stroke Patients with or without Type 2 Diabetes Mellitus. Diabetes, Metabolic Syndrome and Obesity, 18, 1299-1309. [Google Scholar] [CrossRef] [PubMed]
[30] Mi, D., Wang, Y., Wang, Y. and Liu, L. (2020) Insulin Resistance Is an Independent Risk Factor for Early Neurological Deterioration in Non-Diabetic Patients with Acute Ischemic Stroke. Neurological Sciences, 41, 1467-1473. [Google Scholar] [CrossRef] [PubMed]
[31] Ago, T., Matsuo, R., Hata, J., Wakisaka, Y., Kuroda, J., Kitazono, T., et al. (2018) Insulin Resistance and Clinical Outcomes after Acute Ischemic Stroke. Neurology, 90, e1470-e1477. [Google Scholar] [CrossRef] [PubMed]
[32] Li, S., Yin, C., Zhao, W., Zhu, H., Xu, D., Xu, Q., et al. (2018) Homeostasis Model Assessment of Insulin Resistance in Relation to the Poor Functional Outcomes in Nondiabetic Patients with Ischemic Stroke. Bioscience Reports, 38, BSR20180330. [Google Scholar] [CrossRef] [PubMed]
[33] Chang, Y., Kim, C.K., Kim, M., Seo, W. and Oh, K. (2021) Insulin Resistance Is Associated with Poor Functional Outcome after Acute Ischemic Stroke in Non-Diabetic Patients. Scientific Reports, 11, Article No. 1229. [Google Scholar] [CrossRef] [PubMed]
[34] Liao, B., Meng, G. and Liu, X. (2025) Unveiling the Dual Threat: Combined Elevated Triglyceride-Glucose Index and Intracranial Arterial Stenosis Burden for Enhanced Stroke Risk Stratification. Frontiers in Neurology, 16, Article 1561329. [Google Scholar] [CrossRef] [PubMed]
[35] Xu, J., Wang, A., Meng, X., Jing, J., Wang, Y., Wang, Y., et al. (2019) Obesity-stroke Paradox Exists in Insulin-Resistant Patients but Not Insulin Sensitive Patients. Stroke, 50, 1423-1429. [Google Scholar] [CrossRef] [PubMed]
[36] He, L., Li, R., Wang, L., Zhu, X., Zhou, Q., Yang, Z., et al. (2025) Analyzing the Correlation between Acute Ischemic Stroke and Triglyceride-Glucose Index Based on Ordered Logistic Regression. Frontiers in Neurology, 16, Article 1500572. [Google Scholar] [CrossRef] [PubMed]
[37] Magwood, G.S., White, B.M. and Ellis, C. (2017) Stroke-Related Disease Comorbidity and Secondary Stroke Prevention Practices among Young Stroke Survivors. Journal of Neuroscience Nursing, 49, 296-301. [Google Scholar] [CrossRef] [PubMed]
[38] Zawiejska, A., Wróblewska-Seniuk, K., Gutaj, P., Kippen, J., Gomulska, A. and Wender-Ozegowska, E. (2022) Markers of Maternal Insulin Resistance and Lipid Ratios Measured in Early Pregnancy Are Related to Adverse Fetomaternal Outcomes in Women Treated for Hyperglycemia Detected in Early Pregnancy-Data from a Retrospective Cohort Study. Journal of Clinical Medicine, 11, Article 1777. [Google Scholar] [CrossRef] [PubMed]
[39] Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M., Corella, D., Arós, F., et al. (2018) Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. New England Journal of Medicine, 378, e34. [Google Scholar] [CrossRef] [PubMed]
[40] Soliman, S.B., Chugh, O.K., Leuteneker, J.E., Tuska, B., Ye, W., Zhang, T., et al. (2025) Muscle Ultrasound: A Novel Noninvasive Tool for Early Detection of Developing Insulin Resistance and Lower Muscle Mass in Obesity. Journal of Ultrasound in Medicine, 44, 1883-1892. [Google Scholar] [CrossRef] [PubMed]
[41] Borschmann, K.N., Ekinci, E.I., Iuliano, S., Churilov, L., Pang, M.Y. and Bernhardt, J. (2017) Reducing Sedentary Time and Fat Mass May Improve Glucose Tolerance and Insulin Sensitivity in Adults Surviving 6 Months after Stroke: A Phase I Pilot Study. European Stroke Journal, 2, 144-153. [Google Scholar] [CrossRef] [PubMed]
[42] Yaghi, S., Furie, K.L., Viscoli, C.M., Kamel, H., Gorman, M., Dearborn, J., et al. (2018) Pioglitazone Prevents Stroke in Patients with a Recent Transient Ischemic Attack or Ischemic Stroke: A Planned Secondary Analysis of the IRIS Trial (Insulin Resistance Intervention After Stroke). Circulation, 137, 455-463. [Google Scholar] [CrossRef] [PubMed]
[43] Mastrototaro, L. and Roden, M. (2021) Insulin Resistance and Insulin Sensitizing Agents. Metabolism, 125, Article ID: 154892. [Google Scholar] [CrossRef] [PubMed]
[44] Wueest, S., Seelig, E., Timper, K., Lyngbaek, M.P., Karstoft, K., Donath, M.Y., et al. (2021) IL-6 Receptor Blockade Increases Circulating Adiponectin Levels in People with Obesity: An Explanatory Analysis. Metabolites, 11, Article 79. [Google Scholar] [CrossRef] [PubMed]

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