Supplementary file 1_Association between atherogenic index of plasma and post-stroke epilepsy within one year in patients with acute ischemic stroke: a retrospective cohort study.docx

IntroductionAcute ischemic stroke (AIS) is a major cause of death and disability globally. Post-stroke epilepsy (PSE) adversely affects prognosis and quality of life. This retrospective observational study was to explore the association between the atherogenic index of plasma (AIP) and PSE within one year after AIS.
MethodsThis study was a retrospective observational cohort analysis of 20,538 middle-aged and elderly patients with AIS. AIP was calculated as log10 (TG/HDL). Participants were stratified by AIP levels. Multivariable logistic regression, restricted cubic spline analysis, mediation, stratified and interaction analysis were performed.
ResultsElevated AIP was significantly associated with higher odds of PSE. A non-linear threshold effect was identified, with an overall inflection point at 0.048 (males: 0.049; females: 0.026), and the association between AIP and PSE was stronger below this threshold. Mediation analysis indicated a reciprocal mediation between fibrinogen and AIP on PSE. Significant multiplicative and additive interactions of AIP with sex, National Institutes of Health Stroke Scale (NIHSS) and hemoglobin A1c (HbA1c) were observed. Significant additive interactions of AIP with C-reactive protein (CRP) were observed.
ConclusionElevated AIP was associated with higher risk of PSE within one year after AIS. This association exhibited sex-specific threshold effects, a bidirectional mediating relationship with fibrinogen, and interactive effects with sex, HbA1c, CRP, and NIHSS. As a simple metric derived from routine lipid profiles, AIP may be useful for risk stratification.

引言
急性缺血性脑卒中（Acute ischemic stroke, AIS）是全球范围内导致死亡与残疾的主要病因。卒中后癫痫（Post-stroke epilepsy, PSE）会对患者的预后及生活质量产生不良影响。本项回顾性观察研究旨在探讨急性缺血性脑卒中后1年内血浆致动脉粥样硬化指数（atherogenic index of plasma, AIP）与卒中后癫痫的关联。
方法
本研究为一项针对20538名中老年急性缺血性脑卒中患者的回顾性观察队列分析。血浆致动脉粥样硬化指数（AIP）按公式log₁₀（甘油三酯（Triglyceride, TG）/高密度脂蛋白（High-density lipoprotein, HDL））计算得出。研究对象按AIP水平进行分层。本研究采用多变量logistic回归、限制性立方样条分析、中介分析、分层分析及交互作用分析开展统计分析。
结果
升高的AIP水平与卒中后癫痫更高的发生风险显著相关。本研究发现了非线性阈值效应，整体拐点为0.048（男性：0.049；女性：0.026），且当AIP水平低于该拐点时，其与卒中后癫痫的关联强度更强。中介分析结果显示，纤维蛋白原与AIP在卒中后癫痫的发生中存在双向中介作用。此外，AIP与性别、美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）及糖化血红蛋白（hemoglobin A1c, HbA1c）均存在显著的相乘交互作用与相加交互作用；同时，AIP与C反应蛋白（C-reactive protein, CRP）亦存在显著的相加交互作用。
结论
急性缺血性脑卒中后1年内，升高的AIP水平与卒中后癫痫更高的发生风险相关。该关联存在性别特异性的阈值效应，与纤维蛋白原存在双向中介作用，并与性别、糖化血红蛋白、C反应蛋白及美国国立卫生研究院卒中量表存在交互作用。作为一项源自常规血脂检测的简便指标，AIP或可用于急性缺血性脑卒中患者的风险分层。