非高密度脂蛋白胆固醇、TyG指数对急性 缺血性脑卒中后早期认知障碍的预测价值

The Predictive Value of Non-HDL-C and the TyG Index for Early Cognitive Impairment after Acute Ischemic Stroke

摘要: 目的：探讨非高密度脂蛋白胆固醇(non-High-Density Lipoprotein Cholesterol, non-HDL-C)与甘油三酯–葡萄糖指数(Triglyceride-Glucose Index, TyG)单独及联合对急性缺血性脑卒中(Acute Ischemic Stroke, AIS)后早期认知障碍的预测价值。方法：纳入100例AIS患者为研究对象。分为出现早期认知障碍组(50例)与认知正常组(50例)。检测空腹血糖(FPG)、糖化血红蛋白(HbA1C)、同型半胱氨酸(Hcy)、尿酸(UA)及总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、甘油三酯(TG)水平，计算TyG指数及non-HDL-C；认知功能于AIS发病后第7日采用蒙特利尔认知评估量表(Montreal Cognitive Assessment, MoCA)进行评定，以总分 < 26分定义为认知障碍。所有患者于发病后3个月进行随访，再次进行认知评估，以最终评分 < 26分定义为PSCI。使用Logistic回归模型分析相关危险因素，并通过受试者工作特征(Receiver Operating Characteristic, ROC)曲线下面积评估各指标的诊断效能。结果：认知障碍组TyG指数(8.75 ± 0.48 vs. 8.34 ± 0.24)与non-HDL-C [3.17 (2.76, 3.52) vs. 2.94 (2.69, 3.21)]均高于对照组(P < 0.05)。多因素分析显示，二者均为AIS后认知障碍的独立危险因素(P < 0.05)。二者联合应用的预测效能其AUC为0.798 (95% CI: 0.704~0.892, P < 0.001)，敏感度为72%，特异度为90%，优于单一指标。结论：较高的non-HDL-C与TyG指数可独立预测AIS后早期认知障碍风险，联合应用具有更好的预测价值。

Abstract: Objective: To evaluate the predictive value of non-High-Density Lipoprotein Cholesterol (non-HDL-C) and the Triglyceride-Glucose (TyG) index, both individually and in combination, for early cognitive impairment after Acute Ischemic Stroke (AIS). Methods: This study included 100 AIS patients. They were stratified into an early cognitive impairment group and a cognitively normal group (50 cases each). Fasting Plasma Glucose (FPG), glycated Hemoglobin (HbA1c), Homocysteine (Hcy), Uric Acid (UA), Total Cholesterol (TC), High-Density Lipoprotein Cholesterol (HDL-C), Low-Density Lipoprotein Cholesterol (LDL-C), and Triglycerides (TG) levels were measured. The TyG index and non-HDL-C were calculated. Cognitive function was evaluated on day 7 after AIS onset using the Montreal Cognitive Assessment (MoCA), with a score of <26 indicating impairment. All patients underwent follow-up cognitive assessment at 3 months post-onset, with a final score of <26 defining PSCI. Risk factors were analyzed via Logistic regression, and the predictive performance of relevant indicators was analyzed using the Area Under the Receiver operating characteristic curve (AUC). Results: The cognitive impairment group showed significantly higher TyG index (8.75 ± 0.48 vs. 8.34 ± 0.24) and non-HDL-C levels [3.17 (2.76, 3.52) vs. 2.94 (2.69, 3.21)] compared to the control group (P < 0.05). Multivariate analysis identified both as independent risk factors for early cognitive impairment after AIS (P < 0.05). Their combination yielded an AUC of 0.798 (95% CI: 0.704~0.892), with 72% sensitivity and 90% specificity, outperforming either marker alone. Conclusion: Elevated non-HDL-C and TyG index levels are independently associated with an increased risk of early cognitive impairment after AIS. Their combined use offers superior predictive value.