急性缺血性脑卒中患者体质量指数与临床预后及病死率的相关性  

Correlation analysis onbody mass index,clinical symptoms and prognosis,andfatalityrateofpatients with acute ischemic stroke

作　　者：姚涛[1] 田柏淋 湛彦强[1] 李斐 刘璋[1,2] YAO Tao;TIAN Bolin;ZHAN Yanqiang;LI Fei;LIU Zhang(Department of Neurolo gy,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院神经内科,武汉430060 [2]武汉大学人民医院神经外科,武汉430060 [3]湖北省大悟县中医院神经内科,湖北孝感432800

出　　处：《实用医学杂志》2019年第20期3188-3192,共5页The Journal of Practical Medicine

基　　金：2018年武汉大学人民医院引导基金资助项目(编号：RMYD2018M64,RMYD2018M09)

摘　　要：目的探讨急性缺血性脑卒中患者体质量指数(body mass index,BMI)与临床预后及病死率的关系。方法回顾性收集2017年8月至2018年12月于武汉大学人民医院神经内科住院的568例急性缺血性脑卒中患者,收集其临床资料,记录其年龄、性别、BMI、血管危险因素、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、基线血压、空腹血糖等基线资料。根据患者BMI将患者分为4个体质量亚组:体质量过轻组(BMI<18.5 kg/m^2)、正常体质量组(18.5≤BMI<24 kg/m^2),超重组(24≤BMI<28 kg/m^2)以及肥胖组(BMI≥28 kg/m^2)。采用改良Rankin量表(mRS)评分对患者发病后90 d临床预后进行评价(mRS评分>2为预后不良,mRS评分≤2分为预后良好)。用逻辑回归分析BMI与临床预后及病死率的相关性。结果在调整年龄、性别、血管危险因素、NIHSS评分以及脑梗死病因分型等因素影响后,体质量过轻组与正常体质量组相比,90 d预后不良风险显著增加(OR=2.385,95%CI:1.042~5.454;P=0.039);肥胖组90 d预后不良风险差异无统计学意义(OR=0.570,95%CI:0.261~1.248,P=0.160)。体质量过轻组与正常体质量组相比,90 d死亡风险显著增加(OR=2.760,95%CI:1.073~7.098;P=0.035);肥胖组与正常体质量组相比,90 d死亡风险差异无统计学意义(OR=0.349,95%CI:0.099~1.229,P=0.101)。结论体质量过轻的急性缺血性脑卒中患者临床预后不良,有着更高的病死率和致残风险。Objective To investigate the relationship between body mass index(BMI)and unfavorable outcomes and fatality in patients with acute ischemic stroke.Methods We retrospectively included 568 acute ischemic stroke patients hospitalized in theRenmin Hospital of Wuhan University from August 2017 to December 2018.Their clinical data were collected and their age,sex,BMI,vascular risk factors,National Institutes of Health Stroke Scale(NIHSS)score,baseline blood pressure,fasting blood glucose were recorded.According to BMI,patients were divided into four groups:underweight group(BMI<18.5 kg/m^2),normal weight group(18.5≤BMI<24 kg/m^2),overweight group(24≤BMI<28 kg/m2)and obese group(BMI≥28 kg/m^2).The modified Rankin scale(mRS)was used to assess favorable outcome at 90 days(0~2,favorable outcome;3~6,unfavorable outcome;and 6,death).Logistic regression was used to analyze the correlation between BMI and favorable outcome and fatality.Results After adjusting for confounding factors such as age,gender,vascular risk factors,NIHSSs core,the prognostic value of unfavorable outcome in the underweight group was significantly higher than that in the normal weight group at 90 days(OR=2.385,95%CI:1.042~5.454;P=0.039).There was no significant differ ence in the risk of unfavorable outcome in obesity group at 90 days(OR=0.570,95%CI:0.261~1.248,P=0.160).Compared with the normal weight group,the 90 day fatality risk in the overweight group increased significantly(OR=2.760,95%CI:1.073~7.098,P=0.035);there was no significant difference in the 90 day fatality risk between the obese group and the normal weight group(OR=0.349,95%CI:0.099~1.229,P=0.101).Conclusion Underweight patients with acute ischemic stroke have unfavorable outcomes and a higher risk of fatality and disability.

关 键 词：急性缺血性脑卒中 体质量指数 肥胖 预后 病死率 

分 类 号：R74[医药卫生—神经病学与精神病学]