体质量指数与腔隙性脑梗死患者预后的关系研究

Association between body mass index and outcome in lacunar infarction patients

目的探讨体质量指数(BMI)与腔隙性脑梗死患者预后的关系。方法纳入中国脑卒中管理质量评估登记研究(China Quality Evaluation of Stroke Care and Treatment)数据库中TOAST分型为腔隙性脑梗死的患者3410例,其中低体质量组(BMI<18.5kg/m^2)182例、正常体质量组(BMI 18.5~23.9kg/m^2)1639例、超重组(BMI24.0~27.9kg/m^2)1212例和肥胖组(BMI≥28.0kg/m^2)377例。终点事件包括12个月时全因死亡、死亡或严重残疾、感染并发症和脑卒中复发。结果与正常体质量组比较,低体质量组12个月时累计全因死亡率升高(19.1%vs 6.7%,P<0.01),超重组和肥胖组变化无显著差异(6.0%和3.8%vs 6.7%,P>0.05)。多因素分析显示,以正常体质量组为参照,低体质量组12个月累计全因死亡(HR=1.91,95%CI:1.22~2.98,P=0.004)、12个月时死亡或严重残疾(OR=1.50,95%CI:1.05~2.14,P=0.026)及感染并发症(OR=1.92,95%CI:1.21~3.06,P=0.006)的风险更高,脑卒中复发风险无显著差异;超重组和肥胖组患者发生上述终点事件的风险无显著差异。结论腔隙性脑梗死患者中,低体质量伴随脑卒中预后不良风险升高,但脑卒中复发的风险无显著改变。

Objective To study the association between body mass index（BMI）and outcome in lacunar infarction（LA）patients.Methods A total of 3410 LA patients were divided into BMI18.5 kg/m^2 group（n=182）,BMI=18.5-23.9 kg/m^2 group（n=1639）,BMI=24.0-27.9 kg/m^2 group（n=1212）and BMI≥28.0 kg/m^2 group（n=377）according to the TOAST typing in China Quality Evaluation of Stroke Care and Treatment Database.The end events included allcause mortality,death or severe disability,infection complications,and recurrent ischemic stroke at 12 months after onset of LA.Results The total all-cause mortality was significantly higher in BMI〈18.5 kg/m^2 group than in BMI=18.5-23.9 kg/m^2 group（19.1%vs 6.7%,P〈0.01）.No significant difference was found in total all-cause mortality between BMI=24.0-27.9 kg/m^2 group and BMI≥28.0 kg/m^2 group（6.0% and 3.8% vs6.7%,P〈0.05）.Multivariate logistic regression analysis showed that the risk of all-cause mortality,death or severe disability,infection complications,and recurrent ischemic stroke was higher in BMI〈18.5 kg/m^2 group than in BMI=18.5-23.9 kg/m^2 group（HR=1.91,95%CI：1.22-2.98,OR=1.50,95%CI：1.05-2.14,OR=1.92,95%CI：1.21-3.06,P〈0.05,P〈0.01）.No significant difference was found in risk of recurrent ischemic stroke and end events between BMI〈18.5 kg/m^2 group and BMI=18.5-23.9 kg/m^2 group.Conclusion The risk of poor outcome is higher while that of recurrent ischemic stroke remains unchanged in LA patients with their BMI〈18.5 kg/m^2.