不同肥胖指标及糖尿病与缺血性脑卒中关系

Influence of obesity and diabetes on ischemic stroke

目的 探讨不同肥胖指标如体质指数（BMI）、腰臀比（WHR）及糖尿病与缺血性脑卒中（IS）的关系,为采取相应的干预措施提供参考依据。方法 采用以医院为基础的1：1病例对照研究方法对2011年4月＆mdash;2012年9月在辽宁医学院附属第一医院、附属第三医院和锦州市中心医院神经内科住院的311例≥25岁IS患者和同期入住相同医院的311例非脑血管疾病患者进问卷调查、体格检查及实验室检测。结果 多因素logistic 回归分析结果显示,与体重正常者比较,超重和肥胖者发生IS的危险性分别升高57.1%（OR=1.571,95%CI=1.0153~2.582）和77.5%（OR=1.775,95%CI=1.101~2.785）;与WHR最低四分位数者比较,WHR第二、第三和最高四分位数者发生IS的危险性分别升高4.6%（OR=1.046,95%CI=1.012~1.498）、30.7%（OR=1.307,95%CI=1.003~1.721）和36.0%（OR=1.360,95%CI=1.175~1.855）;与空腹血糖（FPG）最低四分位数者比较,FPG第三和最高四分位数者发生IS的危险性分别升高56.6%（OR=1.566,95%CI=1.023~2.314）和79.1%（OR=1.791,95%CI=1.159~2.725）;与非糖尿病者比较,糖尿病者发生IS的危险性升高101.3%（OR=2.013,95%CI=1.245~2.987）;与非糖尿病者比较,糖尿病病程 〈10和10~20年者发生IS的危险性分别升高126.4%和131.7%（OR=2.264,95%CI=1.458~3.532）和（OR=2.264,95%CI=1.120~5.876）。结论 BMI、WHR、FPG升高及糖尿病与IS的发生呈正相关,维持正常体重和血糖可预防IS的发生。

Objective To examine the association between different indicators of adiposity（body mass index [BMI] and wais-tto-hip ratio[WHR]）,diabetes and the risk of ischemic stroke（IS）.Methods A hospital-based case-control study was conducted.Cases（n=311）were patients ≥25 years old with ischemic stroke,who were admitted to Department of Neurology of First Affiliated Hospital and Third Affiliated Hospital of Liaoning Medical University,and Jinzhou Central Hospital between April 2011 to September 2012.Frequency-matched controls（n=311）were patients who had been admitted to the same hospital for diseases not related to stroke.All subjects were surveyed using a structured interviewer-administrated questionnaire and laboratory examinations.Results Multiple logistic regression analyses showed that compared to the controls with normal BMI,overweight and obesity were associated with a significantly increased risk for IS（odds ratio [OR]=1.571,95% confidence interval[95%CI]：1.0153-2.582,P=0.034;OR=1.775,95%CI：1.101-2.785,P=0.002,respectively）.Compared to the controls in the lowest quartile,after adjusting for multiple potential confounders,the risk for IS in the highest quartile of WHR was increased by 36.0%（OR=1.360,95%CI：1.175-1.855,P=0.009）.Compared to the controls in the lowest quartile,the OR for third and the highest quartile of fasting plasma glucose（FPG）were 1.566（95%CI：1.023-2.314,P=0.029）and 1.791（95%CI：1.159-2.725,P=0.018）.Further multivariate logistic regression models showed that participants with diabetes had 2 times risk of IS as did the nondiabetic（OR=2.013,95%CI：1.245-2.987,P〈0.001）.Compared to the nondiabetic,the risk of IS in the participants with diabetes history 〈10 years and 10 to 20 years significantly increased（OR=2.264,95%CI：1.458-3.532,P=0.003;OR=2.317,95%CI：1.120-5.876,P=0.005,respectively）.Conclusion Higher BMI,WHR,and diabetes were positively related to IS.Therefore,keeping normal weight and blood glucose may protect against IS.